Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E2 gel (PROBAAT trial)
Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E2 gel (PROBAAT trial)
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DOI：
10.1111/1471-0528.12221
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发表时间：
2013-07-01
影响因子：
5.8
通讯作者：
Bloemenkamp, K. W. M.
中科院分区：
文献类型：
--
作者：
van Baaren, G. J.;Jozwiak, M.;Bloemenkamp, K. W. M.
目的比较Foley导尿管与前列腺素E2凝胶用于引产的经济效果。设计经济学评价以及随机对照试验。荷兰一所大学和11所教学医院的产科。足月头位单胎妊娠、胎膜完整、宫颈不佳且既往无剖腹产史的计划引产妇女。方法从医院角度进行成本-效果分析。主要结果测量我们估计了从随机化到产后6周与医疗保健利用相关的直接医疗费用。对于剖腹产率、孕产妇和新生儿发病率，我们计算了增量成本-效果比，这代表了预防这些不良结局之一的成本。结果：Foley导尿管组（n=411）和前列腺素E2凝胶组（n=408）每名妇女的平均费用分别为3297欧元和3075欧元，平均差异为222欧元（95%置信区间-157欧元至633欧元）。在Foley导管组中，我们观察到由于较长的产房占用时间和较低的诱导材料和新生儿入院相关费用而导致的较高费用。与前列腺素诱导相比，Foley导管诱导显示出相当的剖腹产率，因此增量成本-效果比没有提供信息。与前列腺素诱导相比，Foley诱导导致更少的新生儿入院（增量成本-效果比2708欧元）和窒息/产后出血（增量成本-效果比5257欧元）。结论导尿管与前列腺素E2引产的成本相当。
Objective To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 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 6weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental cost-effectiveness 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 E2 gel group (n=408), were Euro3297 versus Euro3075, respectively, with an average difference of Euro222 (95% confidence interval -Euro157 to Euro633). 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 Euro2708) and asphyxia/postpartum haemorrhage (incremental cost-effectiveness ratios Euro5257) compared with prostaglandin induction. Conclusions Foley catheter and prostaglandin E2 labour induction generate comparable costs.