Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women.
OBJECTIVE
To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women.


METHODS
A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12% in the 41st week and a cesarean rate of 27% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings.


RESULTS
Compared with expectant management, induction of labor is cost-effective with an incremental cost of $10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations.


CONCLUSIONS
Elective induction of labor at 41 weeks is cost-effective and improves outcomes.
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Anjali J
AJ
Kaimal
Sarah E
SE
Little
Anthony O
AO
Odibo
David M
DM
Stamilio
William A
WA
Grobman
Elisa F
EF
Long
Douglas K
DK
Owens
Aaron B
AB
Caughey
D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000191:economics*; D010298:Parity; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D016896:Treatment Outcome