The cost‐effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate prior to induction of labour

Abstract

Objectives To assess the cost-effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate (IMN) prior to induction of labour.Design Economic evaluation was conducted alongside a randomised placebo controlled trial (the IMOP trial).Setting Large UK maternity hospital.Population A total of 350 nulliparous women with a singleton pregnancy, cephalic presentation ‡37 weeks gestation, requiring cervical ripening prior to induction of labour.Interventions Isosorbide mononitrate (n = 177) or placebo (n = 173) self-administered vaginally at home at 48, 32 and 16 hours prior to the scheduled time of admission for induction.Results Mean health service costs between the period of randomisation and discharge for mother and infant were £1254.86 in the IMN group and £1242.88 in the placebo group, generating a mean cost difference of £11.98 (bootstrap mean cost difference £12.86; 95%CI: )£106.79, £129.39) that was not statistically significant (P = 0.842). The incremental cost per hour prevented from hospital admission to delivery was £7.53. At the notional willingness to pay threshold of £100 per hour prevented from hospital admission to delivery, the probability that IMN is cost-effective was estimated at 0.67. This translated into a mean net monetary benefit of £98.13 for each woman given IMN.Conclusions Although the probability that IMN is cost-effective approaches 0.7 at seemingly low willingness to pay thresholds for an hour prevented from hospital admission to delivery, our results should be viewed in the light of the clinical findings from the IMOP trial.

Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient setting

“…14,16,18 Same result were obtain from sheriff et al (P=0.002) and in Eddama et al result were not significant (P=0.065). 19,20 The caesarean delivery rate was lower in the study group than in the control group (21.7% v/s 36.2%), although the difference was not significant (P=0.081). Similar rates were reported by Agarwal et al (22% v/s 31%), Eddama et al (37% v/s 33%), and Helal et al (7.5% v/s 2.5%).…”

De novo ceramide synthesis is involved in acute inflammation during labor

“…Parturition is characterized by a complex of transcriptionally regulated events that include NF-κB activation and inflammatory mediators as well as multiple contractile genes transcription (Haddad et al, 2006;Christiaens et al, 2008;Eddama et al, 2009). Dysregulation of this mechanism and abnormal, increased or early inflammation characterize parturition complications, such us pre term birth and preeclampsia (Subramaniam et al, 2013;Zhang et al, 2013).…”

Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis

“…There is evidence that inducing labour in women with complications is associated with lower health-service costs than costs associated with expectant management. [11][12][13] However, there is little evidence on the costs associated with specific methods of induction compared with others. Randomised trials in which one method of induction has been compared with another have only rarely included economic analyses.…”

“…For all included trials, we extracted data on trial and patient characteristics, and this is summarised in tables of included studies (see Appendix 5, Reference list for included studies, and Appendix 6, Table of included studies characteristics, Table 38). 11,14,30,31, Study quality was assessed using the methods described in the Cochrane Handbook. 937 For use in a prespecified sensitivity analysis, we assigned a judgement relating to risk of bias (low, high, unclear), based on the allocation concealment domain.…”