Induction of labour using balloon catheter as an outpatient versus
prostaglandin as an inpatient: a cost-effectiveness analysis.
Abstract
Objective: To assess the cost-effectiveness of induction of labour (IOL)
with outpatient balloon catheter cervical priming versus inpatient
prostaglandin (PG) vaginal gel or tape. Design: Economic evaluation
alongside a multi-centre, randomized controlled trial. Setting: Eight
Australian maternity hospitals. Population: A total of n=448 women with
a live singleton pregnancy, cephalic presentation, at or beyond 37+0
weeks gestation, undergoing IOL for low-risk indications between
September 2015 and October 2018. Methods: An economic decision tree
model was designed from a health services perspective. Sensitivity and
subgroup analyses were performed to test the robustness of model
outcomes. Main Outcome Measures: We estimated resource use from time of
IOL to discharge of mother and infant, collected data on health outcomes
(using EQ-5D-3L questionnaire) and reported cost per quality-adjusted
life year (QALY) gained, incremental cost-effect ratio (ICER) and net
monetary benefit (NMB). Results: Deterministic analysis showed lower
mean costs (AUD $7,294 versus AUD $7,585) in the outpatient-balloon
(n=205) compared to the inpatient-PG group (n=243), with better health
outcomes (0.75 vs 0.74 QALYs gained) and overall higher NMB ($30,054 vs
$29,338). In probabilistic analyses outpatient-balloon IOL was
cost-effective in 55.3% of all simulations and 59.1% for women with
favourable cervix (modified Bishop score >3) and 64.5% for
nulliparous women. Conclusions: Outpatient-balloon IOL might be
cost-saving compared to inpatient IOL with PG and is most likely to be
cost-effective for nulliparous women. Funding: There was no external
funding source for this study. Keywords: Decision analysis, labor
induced, cost-effectiveness, prostaglandin, balloon ripening, randomised
controlled trial