title: An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II).
abstract: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.
  
  
  
  A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).
  
  
  
  Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.
  
  
  
  Women diagnosed with non-severe hypertensive disorders of pregnancy between 340/7and 370/7weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring.
  
  
  
  A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge.
  
  
  
  Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge.
  
  
  
  The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI -€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm.
  
  
  
  In women with mild hypertensive disorders between 340/7and 370/7weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications.
  
  
  
  Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: G-J
authors.initials: GJ
authors.lastname: van Baaren
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Broekhuijsen
authors.affiliation: Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Ganzevoort
authors.affiliation: Department of Obstetrics and Gynaecology, ZGT Almelo, Almelo, the Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Sikkema
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Woiski
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.|Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Kwm
authors.initials: K
authors.lastname: Bloemenkamp
authors.affiliation: Department of Obstetrics and Gynaecology, Grow School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Hcj
authors.initials: H
authors.lastname: Scheepers
authors.affiliation: Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands.
authors.forename: H A
authors.initials: HA
authors.lastname: Bremer
authors.affiliation: Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Hertogenbosch, the Netherlands.
authors.forename: Rjp
authors.initials: R
authors.lastname: Rijnders
authors.affiliation: Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van Loon
authors.affiliation: Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: Dam
authors.initials: D
authors.lastname: Perquin
authors.affiliation: Department of Gynaecology and Obstetrics, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
authors.forename: Jmj
authors.initials: J
authors.lastname: Sporken
authors.affiliation: Department of Obstetrics and Gynaecology, Amphia Hospital Breda, Breda, the Netherlands.
authors.forename: Dnm
authors.initials: D
authors.lastname: Papatsonis
authors.affiliation: Department of Obstetrics and Gynaecology, HagaZiekenhuis, The Hague, the Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: van Huizen
authors.affiliation: Department of Obstetrics and Gynaecology, Medical Centre Haaglanden, Den Haag, the Netherlands.
authors.forename: C B
authors.initials: CB
authors.lastname: Vredevoogd
authors.affiliation: Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, the Netherlands.
authors.forename: Jtj
authors.initials: J
authors.lastname: Brons
authors.affiliation: Department of Obstetrics and Gynaecology, Röpcke-Zweers Ziekenhuis, Hardenberg, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kaplan
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: van Kaam
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Groen
authors.affiliation: Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Porath
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: P P
authors.initials: PP
authors.lastname: van den Berg
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: Bwj
authors.initials: B
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Mtm
authors.initials: M
authors.lastname: Franssen
authors.affiliation: Department of Obstetrics and Gynaecology, Atrium Medical Centre, Heerlen, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Langenveld
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000628:therapy*; D007231:Infant, Newborn; D007751:Labor, Induced / Q000191:economics* / Q000379:methods; D009426:Netherlands; D011247:Pregnancy; D011256:Pregnancy Outcome; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology; D057832:Watchful Waiting / Q000191:economics* / Q000379:methods
keywords: Economic evaluation; expectant monitoring; hypertensive disorders; immediate delivery; preterm