title: An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial).
abstract: OBJECTIVE
  To assess the economic consequences of labour induction compared with expectant monitoring in women with gestational hypertension or pre-eclampsia at term.
  
  
  METHODS
  An economic analysis alongside the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT).
  
  
  METHODS
  Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands.
  
  
  METHODS
  Women diagnosed with gestational hypertension or pre-eclampsia between 36(+0) and 41(+0) weeks of gestation, randomly allocated to either induction of labour or expectant monitoring.
  
  
  METHODS
  A trial-based cost-effectiveness analysis was performed from a societal perspective during a 1-year time horizon.
  
  
  METHODS
  One-year costs were estimated and health outcomes were expressed as the prevalence of poor maternal outcome defined as either maternal complications or progression to severe disease.
  
  
  RESULTS
  The average costs of induction of labour (n = 377) were €7077 versus €7908 for expectant monitoring (n = 379), with an average difference of -€831 (95% CI -€1561 to -€144). This 11% difference predominantly originated from the antepartum period: per woman costs were €1259 for induction versus €2700 for expectant monitoring. During delivery, more costs were generated following induction (€2190) compared with expectant monitoring (€1210). No substantial differences were found in the postpartum, follow-up and for non-medical costs.
  
  
  CONCLUSIONS
  In women with gestational hypertension or mild pre-eclampsia at term, induction of labour is less costly than expectant monitoring because of differences in resource use in the antepartum period. As the trial already demonstrated that induction of labour results in less progression to severe disease without resulting in a higher caesarean section rate, both clinical and economic consequences are in favour of induction of labour in these women.
  
  
  BACKGROUND
  The trial has been registered in the clinical trial register as ISRCTN08132825.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands. s.m.vijgen@amc.uva.nl
authors.forename: S M C
authors.initials: SM
authors.lastname: Vijgen
authors.forename: C M
authors.initials: CM
authors.lastname: Koopmans
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: H
authors.initials: H
authors.lastname: Groen
authors.forename: D
authors.initials: D
authors.lastname: Bijlenga
authors.forename: J G
authors.initials: JG
authors.lastname: Aarnoudse
authors.forename: D J
authors.initials: DJ
authors.lastname: Bekedam
authors.forename: P P
authors.initials: PP
authors.lastname: van den Berg
authors.forename: K
authors.initials: K
authors.lastname: de Boer
authors.forename: J M
authors.initials: JM
authors.lastname: Burggraaff
authors.forename: K W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: A P
authors.initials: AP
authors.lastname: Drogtrop
authors.forename: A
authors.initials: A
authors.lastname: Franx
authors.forename: C J M
authors.initials: CJ
authors.lastname: de Groot
authors.forename: A J M
authors.initials: AJ
authors.lastname: Huisjes
authors.forename: A
authors.initials: A
authors.lastname: Kwee
authors.forename: A J
authors.initials: AJ
authors.lastname: van Loon
authors.forename: A
authors.initials: A
authors.lastname: Lub
authors.forename: D N M
authors.initials: DN
authors.lastname: Papatsonis
authors.forename: J A M
authors.initials: JA
authors.lastname: van der Post
authors.forename: F J M E
authors.initials: FJ
authors.lastname: Roumen
authors.forename: H C J
authors.initials: HC
authors.lastname: Scheepers
authors.forename: R H
authors.initials: RH
authors.lastname: Stigter
authors.forename: C
authors.initials: C
authors.lastname: Willekes
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: M G
authors.initials: MG
authors.lastname: Van Pampus
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006295:Health Resources / Q000191:economics; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000191:economics* / Q000628:therapy; D007751:Labor, Induced / Q000191:economics*; D007902:Length of Stay; D009426:Netherlands; D011225:Pre-Eclampsia / Q000191:economics* / Q000628:therapy; D011247:Pregnancy; D057832:Watchful Waiting / Q000191:economics*