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)

METHODS:

• Economic analysis
• Participants
  • Low-risk, nulliparous women enrolled in the ARRIVE trial
• Study design
  • 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
• Primary outcome
  • Relative direct health care costs of maternal and neonatal care from a health system perspective
• Secondary outcomes
  • Costs of each phase of maternal and neonatal care

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Cost of Elective Labor Induction Compared With Expectant Management in Nulliparous Women

Related ObG Topics:

The ARRIVE Trial and Professional Guidance: Elective 39 Week Induction to Reduce the Risk of Cesarean Section

Does Elective Induction of Labor at 39 Weeks Gestation Lead to Improved Maternal and Newborn Outcomes?

Low-Risk Multiparous Women: Induction of Labor at 39 Weeks or Expectant Management?

Is Elective Induction Linked to Lower Risk of C-section?