Economic analysis comparing induction of labor and expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial)

摘要

Objective To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). Design Economic analysis based on a randomized clinical trial. Setting Obstetric departments of eight academic and 52 non-academic hospitals in the Netherlands. Population Women with PPROM near term who were not in labor 24 h after PPROM. Methods A cost-minimization analysis was done from a health care provider perspective, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs. Main outcome measures Primary health outcome was the incidence of neonatal sepsis. Direct medical costs were estimated from start of randomization to hospital discharge of mother and child. Results Induction of labor did not significantly reduce the probability of neonatal sepsis [2.6% vs. 4.1%, relative risk 0.64 (95% confidence interval 0.25-1.6)]. Mean costs per woman were ?8094 for induction and ?7340 for expectant management (difference ?754; 95% confidence interval -335 to 1802). This difference predominantly originated in the postpartum period, where the mean costs were ?5669 for induction vs. ?4801 for expectant management. Delivery costs were higher in women allocated to induction than in women allocated to expectant management (?1777 vs. ?1153 per woman). Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. Conclusions In women with pregnancies complicated by PPROM near term, induction of labor does not reduce neonatal sepsis, whereas costs associated with this strategy are probably higher.