An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial)
An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial)
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DOI：
10.1111/j.1471-0528.2010.02710.x
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发表时间：
2010-12-01
影响因子：
5.8
通讯作者：
Van Pampus, M. G.
中科院分区：
文献类型：
--
作者：
Vijgen, S. M. C.;Koopmans, C. M.;Van Pampus, M. G.
目的 评估妊娠期高血压或先兆子痫妇女引产与预期监测相比的经济后果。设计与足月高血压和先兆子痫干预试验 (HYPITAT) 一起进行的经济分析。在荷兰 6 所大学和 32 所教学医院和地区医院设置产科。人口 妊娠 36(+0) 至 41(+0) 周期间诊断为妊娠期高血压或先兆子痫的妇女方法 从社会角度在 1 年时间范围内进行基于试验的成本效益分析。主要结果指标 估计一年成本，健康结果表示为不良孕产妇结局的发生率，定义为孕产妇并发症或进展为严重疾病。结果 引产 (n = 377) 的平均成本为 (sic)7077，期待监测的 (sic)7908 (n = 379)，平均差异为 -(sic)831（95% CI -(sic)1561 至 -(sic)144）。这 11% 的差异主要源于产前时期：每位女性引产的费用为 (sic)1259，而期待监测的费用为 (sic)2700。在分娩过程中，与期待监测 ((sic)1210) 相比，引产 ((sic)2190) 产生的成本更多。在产后、随访和非医疗费用方面没有发现显着差异。 结论 对于足月患有妊娠高血压或轻度先兆子痫的妇女，由于产前资源利用的差异，引产的成本低于期待监测。由于试验已经表明，引产可以减少严重疾病的进展，同时不会导致更高的剖腹产率，因此临床和经济结果都支持这些妇女进行引产。
Objective To assess the economic consequences of labour induction compared with expectant monitoring in women with gestational hypertension or pre-eclampsia at term.Design An economic analysis alongside the Hypertension and Preeclampsia Intervention Trial At Term (HYPITAT).Setting Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands.Population Women diagnosed with gestational hypertension or pre-eclampsia between 36(+0) and 41(+0) weeks of gestation, randomly allocated to either induction of labour or expectant monitoring.Methods A trial-based cost-effectiveness analysis was performed from a societal perspective during a 1-year time horizon.Main outcome measures One-year costs were estimated and health outcomes were expressed as the prevalence of poor maternal outcome defined as either maternal complications or progression to severe disease.Results The average costs of induction of labour (n = 377) were (sic)7077 versus (sic)7908 for expectant monitoring (n = 379), with an average difference of -(sic)831 (95% CI -(sic)1561 to -(sic)144). This 11% difference predominantly originated from the antepartum period: per woman costs were (sic)1259 for induction versus (sic)2700 for expectant monitoring. During delivery, more costs were generated following induction ((sic)2190) compared with expectant monitoring ((sic)1210). No substantial differences were found in the postpartum, follow-up and for non-medical costs.Conclusion In women with gestational hypertension or mild pre-eclampsia at term, induction of labour is less costly than expectant monitoring because of differences in resource use in the antepartum period. As the trial already demonstrated that induction of labour results in less progression to severe disease without resulting in a higher caesarean section rate, both clinical and economic consequences are in favour of induction of labour in these women.