Introduction
Induction of labour (IOL) is a medical intervention to stimulate the
onset of labour to facilitate vaginal birth of the baby. Despite the
World Health Organisation, recommending IOL ‘only when there is a
clear medical indication for it and the expected benefits outweigh its
potential harms’, there has been an ongoing increasing trend in IOL
worldwide (1). In Australia, less than half (43%) of women now
experience spontaneous labour, with most common medical indication for
IOL reported as diabetes (14%), prolonged pregnancy (12%) and
prelabour rupture of membranes (10%) (2).
Although IOL is very common, there is no standard approach, and numerous
methods and protocols of IOL are utilized. There is some high-quality
data about clinical outcomes to inform best-practice (3-9), but scant
data about women’s healthcare experiences (10-15) and even less is known
as to the healthcare costs. Given limited information on healthcare
costs for IOL and scarce healthcare resources, it is imperative that we
identify methods of IOL that are safe, effective, acceptable to women,
and cost‐effective.
Outpatient management is an appealing approach to undertaking IOL. It
typically involves the woman attending hospital for a pre-IOL
cardiotocography, administration of a cervical priming agent, going
home, and then returning to hospital hours later for an amniotomy and
oxytocin infusion (if labour has not ensued). Recently we published the
largest randomized controlled trial (RCT) of outpatient IOL and
demonstrated that outpatient balloon cervical ripening may be a safer
method of IOL for nulliparous women, compared to using prostaglandin E2
(PG) as an inpatient (16). We have also shown that outpatient balloons
are an acceptable method and more desirable than inpatient management
with PG for many women (15).
This paper presents the cost-effectiveness analysis from our recently
published trial of outpatient IOL (16). The aim was to determine if
there are differences in quality of life and healthcare costs comparing
outpatient cervical priming using a double-balloon catheter with the use
of PG as an inpatient and to assess the overall probability of
cost-effectiveness.