Cost-effectiveness of a delayed pushing policy for patients with epidural anesthesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group.
OBJECTIVE
The purpose of this study was to estimate the economic efficiency of a policy of delayed pushing for nulliparous women who have full dilatation while they are under epidural anesthesia.


METHODS
A cost-effectiveness evaluation was based on a randomized controlled trial. Resource use and clinical effectiveness data were collected for 1862 women who were randomly allocated to either a delayed pushing group (n = 936) or an early pushing group (n = 926). Costs (in 1997 Canadian dollars) were collected for each item of resource use. Sensitivity analysis was used to examine the robustness of the main results.


RESULTS
Delayed pushing was effective at reducing the number of difficult deliveries (relative risk, 0.79; 95% confidence interval, 0.66 to 0.95). The mean cost of intrapartum care was significantly higher in the delayed pushing group ($625.86 vs $557.64; P <.0005). There were no significant differences in mean costs of postnatal care ($2146.67 vs $2133.54; P =.871) or total hospital care ($2772.53 vs $2691.18; P =.324). The incremental cost per difficult delivery prevented was estimated at $1743.06. The incremental cost-effectiveness ratio remained fairly robust with variations in the values of key parameters incorporated into the sensitivity analysis.


CONCLUSIONS
The results of this economic evaluation should inform decision makers determining whether to advocate a policy of delayed pushing for nulliparous women who have full dilatation while they are under epidural anesthesia.
Petrou
S
S
National Perinatal Epidemiology Unit, University of Oxford, Radcliffe Infirmary, UK.
Coyle
D
D
Fraser
W D
WD
D000767:Anesthesia, Epidural; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000517:prevention & control; D011247:Pregnancy; D013997:Time Factors