title: Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E₂ gel (PROBAAT trial).
abstract: OBJECTIVE
  To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 gel.
  
  
  METHODS
  Economic evaluation alongside a randomised controlled trial.
  
  
  METHODS
  Obstetric departments of one university and 11 teaching hospitals in the Netherlands.
  
  
  METHODS
  Women scheduled for labour induction with a singleton pregnancy in cephalic presentation at term, intact membranes and an unfavourable cervix; and without previous caesarean section.
  
  
  METHODS
  Cost-effectiveness analysis from a hospital perspective.
  
  
  METHODS
  We estimated direct medical costs associated with healthcare utilisation from randomisation to 6 weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental cost-effectiveness ratios, which represent the costs to prevent one of these adverse outcomes.
  
  
  RESULTS
  Mean costs per woman in the Foley catheter group (n = 411) and in the prostaglandin E₂ gel group (n = 408), were €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval -€157 to €633). In the Foley catheter group we observed higher costs due to longer labour ward occupation and less cost related to induction material and neonatal admissions. Foley catheter induction showed a comparable caesarean section rate compared with prostaglandin induction, therefore the incremental cost-effectiveness ratio was not informative. Foley induction resulted in fewer neonatal admissions (incremental cost-effectiveness ratio €2708) and asphyxia/postpartum haemorrhage (incremental cost-effectiveness ratios €5257) compared with prostaglandin induction.
  
  
  CONCLUSIONS
  Foley catheter and prostaglandin E2 labour induction generate comparable costs.
authors.affiliation: Department of Obstetrics, Academic Medical Centre, Amsterdam, the Netherlands. g.j.vanbaaren@amc.uva.nl
authors.forename: G J
authors.initials: GJ
authors.lastname: van Baaren
authors.forename: M
authors.initials: M
authors.lastname: Jozwiak
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: K
authors.initials: K
authors.lastname: Oude Rengerink
authors.forename: M
authors.initials: M
authors.lastname: Benthem
authors.forename: M G K
authors.initials: MG
authors.lastname: Dijksterhuis
authors.forename: M E
authors.initials: ME
authors.lastname: van Huizen
authors.forename: P C M
authors.initials: PC
authors.lastname: van der Salm
authors.forename: N W E
authors.initials: NW
authors.lastname: Schuitemaker
authors.forename: D N M
authors.initials: DN
authors.lastname: Papatsonis
authors.forename: D A M
authors.initials: DA
authors.lastname: Perquin
authors.forename: M
authors.initials: M
authors.lastname: Porath
authors.forename: J A M
authors.initials: JA
authors.lastname: van der Post
authors.forename: R J P
authors.initials: RJ
authors.lastname: Rijnders
authors.forename: H C J
authors.initials: HC
authors.lastname: Scheepers
authors.forename: M
authors.initials: M
authors.lastname: Spaanderman
authors.forename: M G
authors.initials: MG
authors.lastname: van Pampus
authors.forename: J W
authors.initials: JW
authors.lastname: de Leeuw
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: K W M
authors.initials: KW
authors.lastname: Bloemenkamp
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D057785:Catheters / Q000191:economics / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D015232:Dinoprostone / Q000008:administration & dosage* / Q000191:economics*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000191:economics / Q000379:methods*; D009426:Netherlands; D011247:Pregnancy; D014546:Urinary Catheterization / Q000191:economics*; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage
chemical_list: D014622:Vaginal Creams, Foams, and Jellies; D015232:Dinoprostone