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- W4239909154 abstract "To investigate the cost-effectiveness of elective induction of labor at 39 weeks A decision analytic model was designed comparing three induction strategies for nulliparas: (a) induction of labor at 39 weeks; (b) expectant management until 40 weeks and (c) expectant management until 41 weeks with antenatal testing starting at 40 weeks. Baseline assumptions were derived from the literature and analysis of the National Birth Data Set and included an IUFD rate of 0.05% in the 39th week and 0.09% in the 40th week, and cesarean rates of 22.3% in women induced at 39 weeks, 24.2% in women induced at 40 weeks, 27% in women induced at 41 weeks, and 21.6% in spontaneously laboring patients. One-way and multi-way sensitivity analyses were conducted to examine the robustness of the findings. Compared to expectant management, induction at 39 weeks results in a lower rate of adverse obstetric outcomes (Table). Induction of labor was marginally cost-effective at $20,222 per quality-adjusted life year (QALY), as it cost on average $316 to gain an additional 0.017 QALYs. As the cesarean rate with induction and the cost of induction of labor rose, or spontaneous labor became more likely, induction became less cost-effective. Elective induction of labor at 39 weeks improves neonatal outcomes. However, cost-effectiveness of this strategy depends on the clinical scenario. Sensitivity analysis shows that women who have the lowest likelihood of spontaneous labor, and therefore the greatest risk of post-term pregnancy, may benefit most from induction of labor at this gestational age; the challenge that remains is how to identify this cohort at 39 weeks." @default.
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- W4239909154 date "2008-12-01" @default.
- W4239909154 modified "2023-09-24" @default.
- W4239909154 title "203: Induction of labor at 39 weeks in nulliparous women: Is it cost-effective?" @default.
- W4239909154 doi "https://doi.org/10.1016/j.ajog.2008.09.230" @default.
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