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Keywords:

  • Cost-effectiveness;
  • expectant monitoring;
  • gestational hypertension;
  • induction of labour;
  • pre-eclampsia

Please cite this paper as: Vijgen S, Koopmans C, Opmeer B, Groen H, Bijlenga D, Aarnoudse J, Bekedam D, van den Berg P, de Boer K, Burggraaff J, Bloemenkamp K, Drogtrop A, Franx A, de Groot C, Huisjes A, Kwee A, van Loon A, Lub A, Papatsonis D, van der Post J, Roumen F, Scheepers H, Stigter R, Willekes C, Mol B, Van Pampus M for the HYPITAT study group. An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial). BJOG 2010;117:1577–1585.

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 Pre-eclampsia 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 €7077 versus €7908 for expectant monitoring (n = 379), with an average difference of −€831 (95% CI −€1561 to −€144). This 11% difference predominantly originated from the antepartum period: per woman costs were €1259 for induction versus €2700 for expectant monitoring. During delivery, more costs were generated following induction (€2190) compared with expectant monitoring (€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.

Trial registration  The trial has been registered in the clinical trial register as ISRCTN08132825.