Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women

Anjali J. Kaimal; Sarah E. Little; Anthony O. Odibo; David M. Stamilio; William A. Grobman; Elisa F. Long; Douglas K. Owens; Aaron B. Caughey

doi:10.1016/j.ajog.2010.08.012

Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women

Anjali J. Kaimal
, Sarah E. Little
, Anthony O. Odibo
, David M. Stamilio
, William A. Grobman
, Elisa F. Long
, Douglas K. Owens
, Aaron B. Caughey

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

47 Scopus citations

Abstract

Objective To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Study Design A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12% in the 41st week and a cesarean rate of 27% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings. Results Compared with expectant management, induction of labor is cost-effective with an incremental cost of $10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations. Conclusion Elective induction of labor at 41 weeks is cost-effective and improves outcomes.

Original language	English (US)
Pages (from-to)	137.e1-137.e9
Journal	American journal of obstetrics and gynecology
Volume	204
Issue number	2
DOIs	https://doi.org/10.1016/j.ajog.2010.08.012
State	Published - Feb 2011

Funding

This study was supported in part by contract 290-02-0017 from the Agency for Healthcare Research and Quality, US Department of Health and Human Services . A.B.C. is supported by the Robert Wood Johnson Foundation as a Physician Faculty Scholar Grant RWJF-61535 .

Funders	Funder number
U.S. Department of Health and Human Services
Robert Wood Johnson Foundation	RWJF-61535
Agency for Healthcare Research and Quality

Keywords

elective induction
induction of labor
postterm pregnancy

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1016/j.ajog.2010.08.012

Cite this

@article{d84607e6e1fe4790bd7b5e0deea0f7e3,

title = "Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women",

abstract = "Objective To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Study Design A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12\% in the 41st week and a cesarean rate of 27\% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings. Results Compared with expectant management, induction of labor is cost-effective with an incremental cost of \$10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations. Conclusion Elective induction of labor at 41 weeks is cost-effective and improves outcomes.",

keywords = "elective induction, induction of labor, postterm pregnancy",

author = "Kaimal, \{Anjali J.\} and Little, \{Sarah E.\} and Odibo, \{Anthony O.\} and Stamilio, \{David M.\} and Grobman, \{William A.\} and Long, \{Elisa F.\} and Owens, \{Douglas K.\} and Caughey, \{Aaron B.\}",

note = "Funding Information: This study was supported in part by contract 290-02-0017 from the Agency for Healthcare Research and Quality, US Department of Health and Human Services . A.B.C. is supported by the Robert Wood Johnson Foundation as a Physician Faculty Scholar Grant RWJF-61535 . ",

year = "2011",

month = feb,

doi = "10.1016/j.ajog.2010.08.012",

language = "English (US)",

volume = "204",

pages = "137.e1--137.e9",

journal = "American journal of obstetrics and gynecology",

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T1 - Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women

AU - Kaimal, Anjali J.

AU - Little, Sarah E.

AU - Odibo, Anthony O.

AU - Stamilio, David M.

AU - Grobman, William A.

AU - Long, Elisa F.

AU - Owens, Douglas K.

AU - Caughey, Aaron B.

N1 - Funding Information: This study was supported in part by contract 290-02-0017 from the Agency for Healthcare Research and Quality, US Department of Health and Human Services . A.B.C. is supported by the Robert Wood Johnson Foundation as a Physician Faculty Scholar Grant RWJF-61535 .

PY - 2011/2

Y1 - 2011/2

N2 - Objective To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Study Design A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12% in the 41st week and a cesarean rate of 27% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings. Results Compared with expectant management, induction of labor is cost-effective with an incremental cost of $10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations. Conclusion Elective induction of labor at 41 weeks is cost-effective and improves outcomes.

AB - Objective To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Study Design A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12% in the 41st week and a cesarean rate of 27% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings. Results Compared with expectant management, induction of labor is cost-effective with an incremental cost of $10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations. Conclusion Elective induction of labor at 41 weeks is cost-effective and improves outcomes.

KW - elective induction

KW - induction of labor

KW - postterm pregnancy

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Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women

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Keywords

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