Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: a cost-effectiveness analysis

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Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: a cost-effectiveness analysis

Alkmark, Mårten, 1973 (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Centre of Perinatal Medicine & Health, Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynaecol, Ctr Perinatal Med & Hlth,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Wennerholm, Ulla-Britt, 1948 (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Centre of Perinatal Medicine & Health, Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynaecol, Ctr Perinatal Med & Hlth,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Saltvedt, S. (författare): Karolinska Institutet

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Bergh, C. (författare): Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Carlsson, Ylva, 1975 (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Centre of Perinatal Medicine & Health, Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynaecol, Ctr Perinatal Med & Hlth,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Elden, Helen, 1959 (författare): Gothenburg University,Göteborgs universitet,Institutionen för vårdvetenskap och hälsa,Institute of Health and Care Sciences,Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden; Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Caring Sci, Gothenburg, Sweden.

Fadl, Helena, 1965- (författare): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Obstetrics and Gynaecology,Örebro Univ, Fac Med & Hlth, Dept Obstet & Gynaecol, Örebro, Sweden.

Jonsson, Maria, 1966- (författare): Uppsala universitet,Klinisk obstetrik

Ladfors, Lars, 1951 (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Centre of Perinatal Medicine & Health, Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynaecol, Ctr Perinatal Med & Hlth,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Sengpiel, Verena, 1977 (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Centre of Perinatal Medicine & Health, Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynaecol, Ctr Perinatal Med & Hlth,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Wesström, Jan, 1963- (författare): Uppsala universitet,Centrum för klinisk forskning Dalarna,Institutionen för kvinnors och barns hälsa

Hagberg, Henrik, 1955 (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Centre of Perinatal Medicine & Health, Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynaecol, Ctr Perinatal Med & Hlth,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Dept Obstet & Gynaecol, Gothenburg, Sweden.

Svensson, Mikael, 1980 (författare): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa,Institute of Medicine, School of Public Health and Community Medicine,School of Public Health & Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Inst Med, Sch Publ Hlth & Community Med, Gothenburg, Sweden.

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2021-10-12
2022
Engelska.
Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:13, s. 2157-2165

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Tidskriftsartikel (refereegranskat)

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Objective: To assess the cost-effectiveness of induction of labour (IOL) at 41 weeks of gestation compared with expectant management until 42 weeks of gestation. Design: A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial. Setting: Fourteen Swedish hospitals during 2016–2018. Population: Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41 weeks of gestation to IOL or to expectant management and induction at 42 weeks of gestation. Methods: Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping. Main outcome measures: The cost per gained life year and per gained QALY. Results: The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was €4108 in the IOL group (n = 1373) and €4037 in the expectant management group (n = 1373), with a mean difference of €71 (95% CI −€232 to €379). The ICER for IOL compared with expectant management was €545 per life year gained and €623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes. Conclusions: Induction of labour at 41 weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42 weeks of gestation using standard threshold values for acceptable cost per life year/QALY. Tweetable abstract: Induction of labour at 41 weeks of gestation is cost-effective compared with expectant management until 42 weeks of gestation.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Nyckelord

Cost-effectiveness
induction of labour
prolonged pregnancy
Cost-effectiveness

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Av författaren/redakt...: Alkmark, Mårten, ...; Wennerholm, Ulla ...; Saltvedt, S.; Bergh, C.; Carlsson, Ylva, ...; Elden, Helen, 19 ...; visa fler...; Fadl, Helena, 19 ...; Jonsson, Maria, ...; Ladfors, Lars, 1 ...; Sengpiel, Verena ...; Wesström, Jan, 1 ...; Hagberg, Henrik, ...; Svensson, Mikael ...; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Hälsovetenskap; och Hälso och sjukvå ...

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Av lärosätet: Göteborgs universitet; Örebro universitet; Uppsala universitet; Karolinska Institutet

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