Expectant Management vs Induction at 39 Weeks: Is There a Difference in Cost?
BACKGROUND AND PURPOSE:
Einerson et al. (Obstetrics & Gynecology, 2020) compared the actual health-system costs of elective labor induction at 39 weeks vs expectant management among patients enrolled at the ARRIVE Utah study sites (see ‘Related ObG Topics’ below for further information on the ARRIVE trial)
Low-risk, nulliparous women enrolled in the ARRIVE trial
Direct health system costs of maternal and neonatal care were measured using advanced costing analytics from the time of randomization (38 weeks of gestation) until exit from the study (up to 8 weeks postpartum)
Costs in each randomization arm were compared | Costs were reported as the relative cost of induction compared with expectant management
With a fixed sample size, this study was powered to detect a ≥7.3% difference in overall costs
Relative direct health care costs of maternal and neonatal care from a health system perspective
Costs of each phase of maternal and neonatal care
1,201 women had cost data available
Total cost of induction was no different than expectant management
Mean difference: +4.7% (95% CI, −2.1% to +12.0%; P =0.18)
The following were found among patients in the induction arm
Maternal outpatient antenatal care costs: 47.0% lower (95% CI −58.3% to −32.6%; P < 0.001)
Maternal inpatient intrapartum and delivery care costs: 16.9% higher (95% CI, +5.5% to +29.5%; P = 0.003)
There was no difference between arms for the following
Maternal inpatient postpartum care
Maternal outpatient care after discharge
Neonatal hospital care
Neonatal care after discharge
The total cost of elective induction of labor at 39 weeks was not significantly different from that of expectant management
The authors state that
This analysis challenges the longstanding assumption that elective induction of labor at term leads to significant cost escalation
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