Cost‐effectiveness of induction of labour at term with aFoley catheter compared to vaginal prostaglandin E₂gel (PROBAATtrial)

Abstract

Objective To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E 2 gel.Design Economic evaluation alongside a randomised controlled trial.Setting Obstetric departments of one university and 11 teaching hospitals in the Netherlands.Population Women scheduled for labour induction with a singleton pregnancy in cephalic presentation at term, intact membranes and an unfavourable cervix; and without previous caesarean section.Methods Cost-effectiveness analysis from a hospital perspective.Main outcome measures We estimated direct medical costs associated with healthcare utilisation from randomisation to 6 weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental costeffectiveness ratios, which represent the costs to prevent one of these adverse outcomes.Results Mean costs per woman in the Foley catheter group (n = 411) and in the prostaglandin E 2 gel group (n = 408), were €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval À€157 to €633). In the Foley catheter group we observed higher costs due to longer labour ward occupation and less cost related to induction material and neonatal admissions. Foley catheter induction showed a comparable caesarean section rate compared with prostaglandin induction, therefore the incremental cost-effectiveness ratio was not informative. Foley induction resulted in fewer neonatal admissions (incremental cost-effectiveness ratio €2708) and asphyxia/postpartum haemorrhage (incremental cost-effectiveness ratios €5257) compared with prostaglandin induction.Conclusions Foley catheter and prostaglandin E 2 labour induction generate comparable costs.

Intravaginal PGE1 versus Intracervical PGE2 for induction of labor: A Comparative Analytical Study

“…According to market values of both the prostaglandin analogues, the average cost of therapy of PGE2 group was significantly higher than that of the PGE1 group, so patients usually prefer PGE1 over PGE2. Similar results were observed by Van Barren et al 19 and Beckmann M et al 20 . In this study the cost of therapy was significantly less in the PGE1 group (Rs 9/-vs. Rs 406.57/-respectively) per woman.…”

Induction of Labour in women with Nonscarred Uterus Using Balloon Catheter: Randomised Controlled Trial

“…There was no morbidity for both mothers and neonates in both groups. When compared to previous studies foley induction seems more safe than prostin induction [5,8,10,11].We did not study the cost effectiveness of foley catheter compared to prostin but this was studied in previous studies and foley induction was found to be cheaper than prostin [1,3]. Women opinion was not studied but previous studies showed that more women were satisfied with foley induction especially that the pain was less than that of prostin induction [1,5,11].…”

“…Induction of labour is a common procedure in now a day's contemporary obstetrics [1][2][3]. Labour induction may be indicated by medical or obstetrical complications of pregnancy or may be requested or chosen for non-medical or social reasons [3,4].…”

Induction of labour using prostaglandin (PGE2) vaginal gel

“…Furthermore, in maternity there is the additional challenge of simultaneously considering the outcomes for both mother and child, and there is no accepted way to do this. Five economic evaluations of RCTs of IOL protocols have been published in the last 6 years [137,139,[218][219][220], but only one has reported QALYs.…”

“…Van Baaren [218], in a comparison of Foley catheters with PGE2 vaginal gel, reported that cost differences in the two groups predominantly originated from differences in the duration of labour ward stay. Eddama [219], in a placebo controlled RCT of outpatient isosorbide mononitrate prior to IOL, identified that the largest cost difference between groups was due to time spent in the antenatal ward.…”