Foley catheter vs. oral misoprostol to induce labour among hypertensive women in India: a cost-consequence analysis alongside a clinical trial


Leigh, S, Granby, P, Haycox, A ORCID: 0000-0001-6659-4866, Mundle, S, Bracken, H, Khedikar, V, Mulik, J, Faragher, B, Easterling, T, Turner, MA ORCID: 0000-0002-5299-8656 et al (show 3 more authors) (2018) Foley catheter vs. oral misoprostol to induce labour among hypertensive women in India: a cost-consequence analysis alongside a clinical trial. BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 125 (13). pp. 1734-1742.

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Abstract

ObjectiveTo determine the effectiveness and economic impact oftwo methods for induction of labour in hypertensive women, inlow-resource settings.DesignCost-consequence analysis of a previously reportedmulticentre, parallel, open-label randomised trial.Setting & populationA total of 602 women with a live fetus, aged≥18 years requiring delivery for pre-eclampsia or hypertension, intwo public hospitals in Nagpur, India.MethodsWe performed a formal economic evaluation alongsidethe INFORM clinical trial. Women were randomised to receivetranscervical Foley catheterisation or oral misoprostol 25 mcg.Healthcare expenditure was calculated using a provider-sidemicrocosting approach.Main outcome measuresRates of vaginal this delivery within24 hours of induction, healthcare expenditure per completedtreatment episode.ResultsInduction with oral misoprostol resulted in a (meandifference) $20.6USD reduction in healthcare expenditure [95%CI ( ) $123.59 ( ) $72.49], and improved achievement ofvaginal delivery within 24 hours of induction, mean difference10% [95% CI ( 2 to 17.9%),P=0.016]. Oxytocinadministration time was reduced by 135.3 minutes [95% CI(84.4–186.2 minutes),P<0.01] and caesarean sections by 9.1%[95% CI (1.1–17%),P=0.025] for those receiving oralmisoprostol. Following probabilistic sensitivity analysis, oralmisoprostol was cost-saving in 63% of 5,000 bootstrapreplications and achieved superior rates of vaginal delivery,delivery within 24 hours of induction and vaginal delivery within24 hours of induction in 98.7%, 90.7%, and 99.4% of bootstrapsimulations. Based on univariate threshold analysis, the unit priceof oral misoprostol 25 mcg could feasibly increase 31-fold from$0.24 to $7.50 per 25 mcg tablet and remain cost-saving.

Item Type: Article
Uncontrolled Keywords: Cost-consequence, economics, hypertension, labour induction, low-resource settings, pre-eclampsia
Depositing User: Symplectic Admin
Date Deposited: 18 Jun 2018 10:18
Last Modified: 19 Jan 2023 01:32
DOI: 10.1111/1471-0528.15285
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3022686
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