An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II).
BJOG
; 124(3): 453-461, 2017 02.
Article
en En
| MEDLINE
| ID: mdl-26969198
ABSTRACT
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 340/7 and 370/7 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 OUTCOMEMEASURES:
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 340/7 and 370/7 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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Costos de la Atención en Salud
/
Hipertensión Inducida en el Embarazo
/
Espera Vigilante
/
Trabajo de Parto Inducido
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Health_economic_evaluation
/
Risk_factors_studies
Límite:
Female
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Humans
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Newborn
/
Pregnancy
País/Región como asunto:
Europa
Idioma:
En
Revista:
BJOG
Asunto de la revista:
GINECOLOGIA
/
OBSTETRICIA
Año:
2017
Tipo del documento:
Article
País de afiliación:
Países Bajos