Active management of labor: a cost analysis of a randomized controlled trial

Objective To compare the costs of a protocol of active management of labor with those of traditional labor management. Design Cost analysis of a rando mized controlled trial. Methods From August 1992 to April 1996, we randomly allocated 405 women whose infants were delivered at the University of New Mexico Health Sciences Center, Albuquerque, to an active management of labo r protocol that had substantially reduced the duration of labor or a contro l protocol. We calculated the average cost for each delivery using both act ual costs and charges. Results The average cost for women assigned to the a ctive management protocol was $2,480.79 compared with an average cost of $2 ,528.61 for women in the control group (P = 0.55). For women whose infant w as delivered by cesarean section, the average cost was $4,771.54 for active management of labor and $4,468.89 for the control protocol (P = 0.16). Spo ntaneous vaginal. deliveries cost an average of $27.00 more for actively ma naged patients compared with the cost for the control protocol. Conclusions The reduced duration of labor by active management did not translate into significant cost savings. Overall, an average cost saving of only $47.91, o r 2%, was achieved for labors that were actively managed. This reduction in cost was due to a decrease in the rate of cesarean sections in women whose labor was actively managed and not to a decreased duration of labor.