An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37?weeks of gestation ( HYPITAT HYPITAT ‐ II II )

摘要

Objective To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non‐severe hypertensive disorders of pregnancy. Design A cost‐effectiveness analysis alongside a randomised controlled trial ( HYPITAT ‐ II ). Setting Obstetric departments of seven academic hospitals and 44 non‐academic hospitals in the Netherlands. Population Women diagnosed with non‐severe hypertensive disorders of pregnancy between 34 0/7 and 37 0/7 ?weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring. Methods A trial‐based cost‐effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. Main outcome measures Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for 24?hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge. Results The average costs of immediate delivery ( n ?=?352) were €10?245 versus €9563 for expectant monitoring ( n ?=?351), with an average difference of €682 (95% confidence interval, 95%? CI ?€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. Conclusion In women with mild hypertensive disorders between 34 0/7 and 37 0/7 ?weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications. Tweetable abstract Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery.