Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.
Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.
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诱导劳动力的方法：系统评价，网络荟萃分析和成本效益分析。
DOI：
10.1111/1471-0528.13981
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Caldwell DM
中科院分区：
文献类型：
--
作者：
Alfirevic Z;Keeney E;Dowswell T;Welton NJ;Medley N;Dias S;Jones LV;Caldwell DM
比较不同引产方法的临床效果和成本-效果。我们对比较晚期妊娠引产干预措施的随机试验进行了系统回顾(搜索日期：2014年3月)。网络Meta分析可以对9个预先指定的关键结果中的6个进行分析：24小时内阴道分娩(VD24)、剖腹产、子宫过度刺激、新生儿重症监护病房(NICU)入院、器质性分娩和婴儿阿普加评分。我们从英国国民健康保险制度的角度开发了一个决策树模型，并计算了增量成本效益比、预期成本、效用和净收益，以及成本效益可接受曲线。总共有611项研究比较了31项积极干预措施。静脉注射催产素联合羊膜切开术和经阴道米索前列醇(≥50μg)最有可能达到VD24。滴定的小剂量口服米索前列醇的剖宫产率最低，但在排名估计方面存在相当大的不确定性。阴道(≥50μg)和口腔/舌下米索前列醇最有可能增加子宫过度刺激，在排名估计中具有较高的不确定性。与安慰剂相比，羊膜外前列腺素E2减少了NICU的入院率。没有足够的数据对产妇和新生儿死亡率以及严重发病率或产妇满意度进行分析。排除高偏倚风险的研究后，结论是可靠的。由于VD24的报告不佳，成本-效果分析比较了20种干预措施的子集。估计有相当大的不确定性，但口腔/舌下和滴定(低剂量)米索前列醇显示出最具成本效益的可能性最高。未来的试验应该设计并提供动力，以检测一种比小剂量滴定口服米索前列醇更具成本效益的方法。一项新的研究根据效果和成本对孕妇引产的方法进行了排名。一项新的研究根据效果和成本对孕妇引产的方法进行了排名。
To compare the clinical effectiveness and cost‐effectiveness of labour induction methods. We conducted a systematic review of randomised trials comparing interventions for third‐trimester labour induction (search date: March 2014). Network meta‐analysis was possible for six of nine prespecified key outcomes: vaginal delivery within 24 hours (VD24), caesarean section, uterine hyperstimulation, neonatal intensive care unit (NICU) admissions, instrumental delivery and infant Apgar scores. We developed a decision‐tree model from a UK NHS perspective and calculated incremental cost‐effectiveness ratios, expected costs, utilities and net benefit, and cost‐effectiveness acceptability curves. In all, 611 studies comparing 31 active interventions were included. Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 μg) were most likely to achieve VD24. Titrated low‐dose oral misoprostol achieved the lowest odds of caesarean section, but there was considerable uncertainty in ranking estimates. Vaginal (≥50 μg) and buccal/sublingual misoprostol were most likely to increase uterine hyperstimulation with high uncertainty in ranking estimates. Compared with placebo, extra‐amniotic prostaglandin E2 reduced NICU admissions. There were insufficient data to conduct analyses for maternal and neonatal mortality and serious morbidity or maternal satisfaction. Conclusions were robust after exclusion of studies at high risk of bias. Due to poor reporting of VD24, the cost‐effectiveness analysis compared a subset of 20 interventions. There was considerable uncertainty in estimates, but buccal/sublingual and titrated (low‐dose) misoprostol showed the highest probability of being most cost‐effective. Future trials should be designed and powered to detect a method that is more cost‐effective than low‐dose titrated oral misoprostol. New study ranks methods to induce labour in pregnant women on effectiveness and cost. New study ranks methods to induce labour in pregnant women on effectiveness and cost.
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DOI：
10.1136/bmj.e6226
发表时间：
2012-10-09
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Haas DM;Caldwell DM;Kirkpatrick P;McIntosh JJ;Welton NJ
通讯作者：
Welton NJ
DOI：
10.1111/j.1471-0528.2009.02236.x
发表时间：
2009-08-01
影响因子：
5.8
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通讯作者：
Norman, J. E.
DOI：
10.1016/j.ijgo.2012.12.009
发表时间：
2013-05-01
影响因子：
3.8
作者：
Tang, Jennifer;Kapp, Nathalie;de Souza, Joao Paulo
通讯作者：
de Souza, Joao Paulo
DOI：
10.1111/1471-0528.12221
发表时间：
2013-07-01
影响因子：
5.8
作者：
van Baaren, G. J.;Jozwiak, M.;Bloemenkamp, K. W. M.
通讯作者：
Bloemenkamp, K. W. M.
DOI：
10.1111/j.1471-0528.2011.02902.x
发表时间：
2011-05-01
影响因子：
5.8
作者：
Petrou, S.;Taher, S. E.;Bennett, P.
通讯作者：
Bennett, P.