COST-EFFECTIVENESS OF INDUCTION OF LABOR VERSUS SERIAL ANTENATAL MONITORING IN THE CANADIAN MUILTICENTRE POSTTERM PREGNANCY TRIAL

Objective: To determine the cost-effectiveness of induction of labour versus serial fetal monitoring while awaiting spontaneous labour in po stterm pregnancies. Design: Cost-effectiveness and cost-minimization a nalyses conducted as part of a Canadian multicentre randomized clinica l trial. Setting: Twenty-two Canadian hospitals, of which 19 were teac hing hospitals and 3 were community hospitals. Patients: Women with un complicated pregnancies of 41 or more weeks' gestation were randomly a ssigned to induction of labour or serial antenatal monitoring. Of the 3418 women enrolled, no data were received on 11. Therefore, results w ere based on data from 1701 women in the induction arm of the study an d 1706 women in the monitoring arm. Main outcome measures: Perinatal m ortality and neonatal morbidity, rates of cesarean section and health care costs. Hospital costing models were developed specifically for th e study. Data on use of major resources (e.g., length of hospital stay , surgical procedures, major diagnostic tests and procedures, and medi cations) for all trial participants were collected and combined with d ata on minor tests and procedures (e.g., laboratory tests) abstracted from a detailed review of medical records of a sample of patients. Res ults: Because the results of the clinical trial showed a nonsignifican t difference in perinatal mortality and neonatal morbidity between the induction and monitoring arms, the authors conducted a cost-minimizat ion rather than a cost-effectiveness analysis. The mean cost per patie nt with a postterm pregnancy managed through monitoring was $3132 (95% confidence interval [CI] $3090 to $3174) and per patient who underwen t induction of labour was $2939 (95% CI $2898 to $2981), for a differe nce of $193. The significantly higher (p < 0.0001) mean cost per patie nt in the monitoring arm was due mainly to the costs of additional mon itoring and the significantly higher rates of cesarean section among t hese patients. Estimated conservatively, the savings resulting from a universal policy of managing postterm pregnancies by induction of labo ur in Canada may be as high as $8 million a year. Conclusions: A polic y of managing postterm pregnancy through induction of labour not only results in more favourable outcomes than a monitoring strategy but doe s so at a lower cost.