title: Economic implications of labor induction.
abstract: OBJECTIVE
  To assess health service costs associated with labor induction according to different clinical situations in a tertiary-level hospital.
  
  
  METHODS
  In a prospective study, individual patient cost data were assessed for women admitted for induction of labor at a tertiary hospital in Spain between November 1, 2012, and August 31, 2013. The costs of labor induction were estimated according to maternal and neonatal outcomes, method of delivery, cervical condition at admission, and obstetric indication. Direct costs including professional fees, epidural, maternal stay, consumables, and drugs were calculated.
  
  
  RESULTS
  Overall, 412 women were included in the final cost analysis. The mean total cost of labor induction was €3589.87 (95% confidence interval [CI] 3475.13-3704.61). Cesarean delivery after labor induction (€4830.45, 95% CI 4623.13-5037.58) was significantly more expensive than spontaneous delivery (€3037.45, 95% CI 2966.91-3179.99) and instrumental vaginal delivery (€3344.31, 95%CI 3151.69-3536.93). The total cost for patients with a very unfavorable cervix (Bishop score <2; €4283.47, 95% CI 4063.06-4503.88) was almost double that for women with a favorable cervix (€2605.09, 95% CI 2327.38-2837.58). Labor induction for hypertensive disorders of pregnancy was the most expensive obstetric indication for induction of labor (€4347.32, 95% CI 3890.45-4804.18).
  
  
  CONCLUSIONS
  Following the induction of labor, a number of patient- and treatment-related factors influence costs associated with delivery.
authors: Obstetrics Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain. Electronic address: raquelgasi@gmail.com.
authors: Raquel
authors: R
authors: Garcia-Simon
authors: Faculty of Economics and Business, University of Zaragoza, Spain.
authors: Antonio
authors: A
authors: Montañes
authors: Faculty of Economics and Business, University of Zaragoza, Spain.
authors: Jesús
authors: J
authors: Clemente
authors: Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain; Unidad de Codificación e Información, ClínicaCoding and Clinical Information Unit, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
authors: María D
authors: MD
authors: Del Pino
authors: Obstetrics Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
authors: Manuel A
authors: MA
authors: Romero
authors: Obstetrics Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
authors: Ernesto
authors: E
authors: Fabre
authors: Obstetrics Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
authors: Daniel
authors: D
authors: Oros
mesh_terms: D000328:Adult; D002584:Cervix Uteri; D002585:Cesarean Section / Q000191:economics; D036861:Delivery, Obstetric / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000191:economics; D007751:Labor, Induced / Q000191:economics / Q000379:methods*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics*; D011446:Prospective Studies; D013030:Spain; D062606:Tertiary Care Centers
keywords: Cost; Delivery; Economic implications; Labor induction; Medical grounds