INDUCTION OF LABOR VERSUS EXPECTANT MANAGEMENT FOR PRELABOR RUPTURE OF THE MEMBRANES AT TERM - AN ECONOMIC-EVALUATION

Background: As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal inf ection. Recently the TERMPROM (Term Prelabor Rupture of the Membranes) Study Group reported the results of a randomized controlled trial com paring 4 management strategies: induction with oxytocin (IwO), inducti on with prostaglandin (IwP), and expectant management and induction wi th either oxytocin (EM-O) or prostaglandin (EM-P) if complications dev eloped. The study found no statistically significant differences in ne onatal infection and cesarean section rates between any of the 4 group s. Objective: To conduct an economic evaluation comparing the cost of (a) IwO and EM-O, (b) IwP and EM-P and (c) IwO and IwP. Design: An eco nomic analysis, conducted alongside the clinical trial, using a third- party payer perspective. Analysis included all treatment costs incurre d for both the mother and the baby. information on health care utiliza tion and outcomes was collected for all study participants. Three coun tries (Canada, the United Kingdom and Australia), corresponding to the largest study recruitment, were chosen for calculation of unit costs. For each country, the base, low and high estimates of unit cost for e ach service item were generated. Intention-to-treat analysis. Extensiv e statistical and sensitivity analyses were performed. Results: The me dian cost of IwO per patient was significantly lower statistically tha n that of EM-O and IwP. This result held in all 3 countries compared ( -$114 and -$46 in Canada, -pound 113 and -pound 63 in the UK, and -A$3 0 and -A$49 in Australia) and after an extensive sensitivity analysis. There was no statistically significant difference in median cost per patient between IwP and EM-P. Conclusion: Although the clinical result s of the TERMPROM study did not find IwO to be preferable to the other treatment alternatives, the economic evaluation found it to be less c ostly. However, these cost differences, even though statistically sign ificant, are not likely to be important in many countries. When this i s the case, the authors recommend that women be offered a choice betwe en management strategies.