title: Cost-effectiveness of term induction of labour using inpatient prostaglandin gel versus outpatient Foley catheter.
abstract: OBJECTIVE
  Evaluating cost-effectiveness of induction of labour (IOL) using outpatient mechanical cervical ripening using a Foley catheter (OFC) compared to inpatient chemical ripening using prostin gel (IPG).
  
  
  METHODS
  Cost-effectiveness analysis from a hospital perspective alongside a RCT. Women in a metropolitan Australian maternity hospital with an unfavourable cervix requiring IOL at term were randomised to IPG (n = 51) or OFC (n = 50). Primary economic measures were mean patient costs, incremental cost per predelivery inpatient hour prevented, and incremental cost per vaginal delivery within 12 h of admission to the birthing unit. Bootstrapping estimates were used to construct 95% confidence intervals. Estimates of net monetary benefit were calculated to aid interpretation of the results.
  
  
  RESULTS
  Mean hospital costs per woman were nonsignificantly higher ($6524 OFC vs $5876 IPG) and mean difference $643; 95% CI -$366 to $1652. OFC group experienced fewer predelivery inpatient hours, resulting in an incremental cost per inpatient hour prevented of $57 (95% CI -$79.44 to $190.65). However, OFC patients were less likely to deliver vaginally within 12 h of admission to birthing unit. Other cost influencing clinical outcomes, including caesarean section rates and total inpatient hours, were not statistically different. Results were not sensitive to changes in costs or the cost-effectiveness thresholds.
  
  
  CONCLUSIONS
  OFC had fewer inpatient hours and costs prior to birth. However, OFC did not reduce overall inpatient hours and failed to achieve comparable rates of vaginal delivery within 12 h of birthing unit admission. Therefore, OFC is unlikely to be considered cost-effective compared to IPG in current hospital settings.
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Austin
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Chambers
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology, Ultimo, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: de Abreu Lourenco
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales (UNSW), Randwick, New South Wales, Australia.
authors.forename: Arushi
authors.initials: A
authors.lastname: Madan
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.
authors.forename: Daniella
authors.initials: D
authors.lastname: Susic
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.|School of Women's and Children's Health, UNSW Medicine, University of New South Wales (UNSW), Randwick, New South Wales, Australia.|Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Henry
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001315:Australia; D020070:Cervical Ripening / Q000187:drug effects; D002585:Cesarean Section / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D005782:Gels; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000379:methods*; D010045:Outpatients / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011453:Prostaglandins / Q000191:economics* / Q000627:therapeutic use*; D047929:Term Birth; D014546:Urinary Catheterization / Q000191:economics* / Q000379:methods
chemical_list: D005782:Gels; D011453:Prostaglandins
keywords: Foley catheter; chemical cervical ripening; cost-effectiveness; induction of labour; mechanical cervical ripening