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.