Grand Rounds

Foley vs Misoprotol: What is the Most Cost-Effective Way to Induce Labor?

BACKGROUND AND PURPOSE:

In a previous RCT (Lancet, 2016 – see ‘Related ObG Topics’ below), investigators determined that
- Both misoprostol and Foley catheter will work when considering induction in an unfavorable cervix at term
- 50 micrograms oral misoprosotol every 4 hours or a 30 ml transcervical Foley catheter did not show a difference in safety profile when looking at fetal asphyxia or postpartum hemorrhage
Eikelder et al. (BJOG, 2017) sought to assess the cost of labor induction associated with oral misoprostol vs. catheter

Economic analysis in parallel to randomized controlled trial (RCT)
Women with unfavorable cervix (Bishop score <6) without previous cesarean section were randomized into two in labor induction treatments:
- Oral misoprostol (n = 924)
- Foley catheter (n = 921)
Economic analysis from a hospital perspective was conducted with estimates of medical costs associated with healthcare utilization from randomization until discharge
The primary outcome was mean cost and differences per woman

Mean cost per woman was similar among groups (conversion 1€=1.35$)
- Oral misoprostol group cost €4,470 ($6,047)
- Foley catheter group cost €4,158 ($5,625)
However, if Foley catheter induction was carried out in an outpatient setting and admission only at start of active labor
- Oral misoprostol group cost €4,470 ($6,047)
- Foley catheter group cost €3,489 ($4,720)

Induction of labor using a Foley catheter or oral misoprostol are equivalent, but Foley is more cost-effective if ripening done on an outpatient basis, with the potential to save approximately €1,000 ($1,350) per woman

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