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Keywords:

  • Cost-effectiveness;
  • Foley catheter;
  • induction of labour;
  • prostaglandin;
  • randomised controlled trial

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 6 weeks 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 €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval −€157 to €633). 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 €2708) and asphyxia/postpartum haemorrhage (incremental cost-effectiveness ratios €5257) compared with prostaglandin induction.

Conclusions

Foley catheter and prostaglandin E2 labour induction generate comparable costs.