Labour induction near term for women aged 35 or over: an economic evaluation

Walker, Kate F.; Dritsaki, M.; Bugg, George; Macpherson, Marion; McCormick, Carol; Grace, Nicky; Wildsmith, Chris; Bradshaw, Lucy; Smith, Gordon C.S.; Thornton, Jim

Abstract

Objective Induction of labour at 39 weeks for nulliparous women aged 35 years and over may prevent stillbirths and does not increase caesarean births, so it may be popular. But the overall costs and benefits of such a policy have not been compared.
Design A cost–utility analysis alongside a randomised controlled trial (the 35/39 trial).
Setting Obstetric departments of 38 UK National Health Service hospitals and one UK primary-care trust.
Population Nulliparous women aged 35 years or over on their expected due date, with a singleton live fetus in a cephalic presentation.
Methods Costs were estimated from the National Health Service and Personal Social Services perspective and quality-adjusted life-years (QALYs) were calculated based on patient responses to the EQ-5D at baseline and 4 weeks.
Main outcome measures Data on antenatal care, mode of delivery, analgesia in labour, method of induction, EQ-5D (baseline and 4 weeks postnatal) and participant-administered postnatal health resource use data were collected.
Results The intervention was associated with a mean cost saving of £263 and a small additional gain in QALYs (though this was not statistically significant), even without considering any possible QALY gains from stillbirth prevention.
Conclusion A policy of induction of labour at 39 weeks for women of advanced maternal age would save money.

Citation

Walker, K. F., Dritsaki, M., Bugg, G., Macpherson, M., McCormick, C., Grace, N., …Thornton, J. (2017). Labour induction near term for women aged 35 or over: an economic evaluation. BJOG: An International Journal of Obstetrics and Gynaecology, 124(6), 929-934. https://doi.org/10.1111/1471-0528.14557

• Journal Article Type: Article
• Acceptance Date: Jan 8, 2017
• Online Publication Date: Mar 16, 2017
• Publication Date: Apr 21, 2017
• Deposit Date: May 11, 2017
• Publicly Available Date: May 11, 2017
• Journal: BJOG: An International Journal of Obstetrics & Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 124
• Issue: 6
• Pages: 929-934
• DOI: https://doi.org/10.1111/1471-0528.14557
• Keywords: Cost-effectiveness; cost–utility; expectant management; induction of labour; nulliparous; advanced maternal age
• Public URL: https://nottingham-repository.worktribe.com/output/857191
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14557/abstract
• Additional Information: This is the peer reviewed version of the following article: K.F.Walker, M.Dritsaki, G.Bugg, M.Macpherson , C.McCormick, N.Grace, C.Wildsmith, L.Bradshaw, G.C.S.Smith, J.G. Thornton. Labour induction near term for women aged 35 or over: an economic evaluation, BJOG, v. 124, issue 6, 2017, p. 929-934, which has been published in final form at doi:10.1111/1471-0528.14557. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
• Contract Date: May 11, 2017