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Randomised trial of one versus two doses of prostaglandin E 2 for induction of labour: 2. Analysis of cost
Ist Teil von
BJOG : an international journal of obstetrics and gynaecology, 1997-09, Vol.104 (9), p.1068-1072
Erscheinungsjahr
1997
Link zum Volltext
Quelle
Wiley Online Library
Beschreibungen/Notizen
Objective To compare the impact upon maternity unit resources and finances of two protocols for induction of labour using prostaglandins. Design A prospective randomised trial comparing a single dose of prostaglandin E 2 (2 mg) in the evening with two doses of prostaglandin E 2 (2 mg), the second being given after six hours if labour had not started or the cervix was still unripe, followed if necessary by formal induction of labour by amniotomy and oxytocin infusion 14 to 20 hours after the initial prostaglandin E 2 dose. Outcome for nulliparae and multiparae were analysed separately, by treatment intention. Setting A maternity unit in a district general hospital delivering > 6000 women annually. Participants Nine hundred and fifty‐five women with viable singleton pregnancies and cephalic presentation at term without previous history of caesarean section who were advised to have labour induced with prostaglandins. Main outcome measures Costs incurred in managing all aspects of labour, including time spent on the antenatal ward and, in the delivery unit; costs associated with formal induction, augmentation of labour and epidural analgesia; costs of intrapartum maternal morbidity, mode of delivery and immediate neonatal care. Costs of postpartum hospital stay were estimated from unit statistics. Results The overall mean cost of induction of labour was £5.00 and £7.22 less per woman for nulliparae and multiparae, respectively, if the two dose regimen was used. The main reason for the differences was due to delivery suite costs from the slightly greater rate of assisted deliveries in the single treatment groups. In contrast, costs for neonatal care were marginally lower if only one prostaglandin dose was used. Conclusions The increased drug costs providing two prostaglandin E 2 doses when required were off‐set by reductions in the costs of other intrapartum interventions for both nulliparae and multiparae. The advantages of less time spent on the antenatal ward for multiparae when two prostaglandin E 2 doses were used may be eliminated if amniotomy and oxytocin infusion was commenced six hours after the initial prostaglandin dose had been given if labour had not started.