The cost-effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate prior to induction of labour
The cost-effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate prior to induction of labour
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DOI：
10.1111/j.1471-0528.2009.02236.x
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发表时间：
2009-08-01
影响因子：
5.8
通讯作者：
Norman, J. E.
中科院分区：
文献类型：
--
作者：
Eddama, O.;Petrou, S.;Norman, J. E.
目的评价门诊(居家)单硝酸异山梨酯(IMN)引产前应用单硝酸异山梨酯(IMN)促宫颈成熟的成本-效果。设计经济学评价与随机安慰剂对照试验(IMOP试验)。设置英国大型妇产科医院。人口共350例单胎妊娠、头位先露和GT的未产妇；单硝酸异山梨酯(n=177)和安慰剂(n=173)分别于入院前48、32和16小时在家中自行阴道给药引产。结果母婴随机分组至出院期间的平均医疗服务成本，IMN组为1254.86磅，安慰剂组为1242.88磅，平均成本差异为11.98磅(自举平均成本差异12.86；95%可信区间：-106.79磅，129.39磅，差异无统计学意义(P=0.842)。从入院到分娩每小时的增量成本为7.53英镑。在理论上愿意支付从入院到分娩的每小时100英镑的门槛时，IMN具有成本效益的概率估计为0.67。这意味着每名服用IMN的妇女平均净货币收益为98.13英镑。结论尽管IMN具有成本效益的概率接近0.7，但在从入院到分娩的一小时内，似乎很低的意愿支付阈值，我们的结果应该根据IMOP试验的临床结果来看待。
ObjectivesTo assess the cost-effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate (IMN) prior to induction of labour.DesignEconomic evaluation was conducted alongside a randomised placebo controlled trial (the IMOP trial).SettingLarge UK maternity hospital.PopulationA total of 350 nulliparous women with a singleton pregnancy, cephalic presentation >= 37 weeks gestation, requiring cervical ripening prior to induction of labour.InterventionsIsosorbide 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.ResultsMean health service costs between the period of randomisation and discharge for mother and infant were 1254.86 pound in the IMN group and 1242.88 pound in the placebo group, generating a mean cost difference of 11.98 pound (bootstrap mean cost difference 12.86; pound 95%CI: -106.79 pound, 129.39) pound that was not statistically significant (P = 0.842). The incremental cost per hour prevented from hospital admission to delivery was 7.53 pound. At the notional willingness to pay threshold of 100 pound 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 pound for each woman given IMN.ConclusionsAlthough 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.