title: Labour induction near term for women aged 35 or over: an economic evaluation.
abstract: OBJECTIVE
  Induction of labour at 39 weeks for nulliparous women aged 35 years and over may prevent stillbirths and does not increase caesarean births, so it may be popular. But the overall costs and benefits of such a policy have not been compared.
  
  
  METHODS
  A cost-utility analysis alongside a randomised controlled trial (the 35/39 trial).
  
  
  METHODS
  Obstetric departments of 38 UK National Health Service hospitals and one UK primary-care trust.
  
  
  METHODS
  Nulliparous women aged 35 years or over on their expected due date, with a singleton live fetus in a cephalic presentation.
  
  
  METHODS
  Costs were estimated from the National Health Service and Personal Social Services perspective and quality-adjusted life-years (QALYs) were calculated based on patient responses to the EQ-5D at baseline and 4 weeks.
  
  
  METHODS
  Data on antenatal care, mode of delivery, analgesia in labour, method of induction, EQ-5D (baseline and 4 weeks postnatal) and participant-administered postnatal health resource use data were collected.
  
  
  RESULTS
  The intervention was associated with a mean cost saving of £263 and a small additional gain in QALYs (though this was not statistically significant), even without considering any possible QALY gains from stillbirth prevention.
  
  
  CONCLUSIONS
  A policy of induction of labour at 39 weeks for women of advanced maternal age would save money.
  
  
  CONCLUSIONS
  A policy of induction of labour at 39 weeks of gestation for women of advanced maternal age would save money.
authors.affiliation: Obstetrics and Gynaecology, Clinical Sciences, University of Nottingham, Nottingham, UK.
authors.forename: K F
authors.initials: KF
authors.lastname: Walker
authors.affiliation: Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dritsaki
authors.affiliation: Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: G
authors.initials: G
authors.lastname: Bugg
authors.affiliation: Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Macpherson
authors.affiliation: Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: McCormick
authors.affiliation: Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Grace
authors.affiliation: Stillbirth and neonatal death charity (SANDS), London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Wildsmith
authors.affiliation: Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Bradshaw
authors.affiliation: Obstetrics and Gynaecology, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
authors.forename: Gcs
authors.initials: G
authors.lastname: Smith
authors.affiliation: Obstetrics and Gynaecology, Clinical Sciences, University of Nottingham, Nottingham, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Thornton
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000191:economics* / Q000379:methods; D008423:Maternal Age; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D047929:Term Birth; D006113:United Kingdom
keywords: Cost-effectiveness; advanced maternal age; cost-utility; expectant management; induction of labour; nulliparous