Economic analysis comparing induction of labour and expectant management for intrauterine growth restriction at term (DIGITAT trial).
Eur J Obstet Gynecol Reprod Biol
; 170(2): 358-63, 2013 Oct.
Article
em En
| MEDLINE
| ID: mdl-23910171
ABSTRACT
OBJECTIVE:
Pregnancies complicated by intrauterine growth restriction (IUGR) are at increased risk for neonatal morbidity and mortality. The Dutch nationwide disproportionate intrauterine growth intervention trial at term (DIGITAT trial) showed that induction of labour and expectant monitoring were comparable with respect to composite adverse neonatal outcome and operative delivery. In this study we compare the costs of both strategies. STUDYDESIGN:
A cost analysis was performed alongside the DIGITAT trial, which was a randomized controlled trial in which 650 women with a singleton pregnancy with suspected IUGR beyond 36 weeks of pregnancy were allocated to induction or expectant management. Resource utilization was documented by specific items in the case report forms. Unit costs for clinical resources were calculated from the financial reports of participating hospitals. For primary care costs Dutch standardized prices were used. All costs are presented in Euros converted to the year 2009.RESULTS:
Antepartum expectant monitoring generated more costs, mainly due to longer antepartum maternal stays in hospital. During delivery and the postpartum stage, induction generated more direct medical costs, due to longer stay in the labour room and longer duration of neonatal high care/medium care admissions. From a health care perspective, both strategies generated comparable costs on average 7106 per patient for the induction group (N=321) and 6995 for the expectant management group (N=329) with a cost difference of 111 (95%CI -1296 to 1641).CONCLUSION:
Induction of labour and expectant monitoring in IUGR at term have comparable outcomes immediately after birth in terms of obstetrical outcomes, maternal quality of life and costs. Costs are lower, however, in the expectant monitoring group before 38 weeks of gestation and costs are lower in the induction of labour group after 38 weeks of gestation. So if induction of labour is considered to pre-empt possible stillbirth in suspected IUGR, it is reasonable to delay until 38 weeks, with watchful monitoring.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Ensaios Clínicos Controlados Aleatórios como Assunto
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Retardo do Crescimento Fetal
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Conduta Expectante
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Trabalho de Parto Induzido
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article