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Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women

Published:October 21, 2010DOI:https://doi.org/10.1016/j.ajog.2010.08.012

      Objective

      To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women.

      Study Design

      A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12% in the 41st week and a cesarean rate of 27% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings.

      Results

      Compared with expectant management, induction of labor is cost-effective with an incremental cost of $10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations.

      Conclusion

      Elective induction of labor at 41 weeks is cost-effective and improves outcomes.

      Key words

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      Linked Article

      • Cost-effectiveness of induced labor: by Kaimal et al
        American Journal of Obstetrics & GynecologyVol. 204Issue 2
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          The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Kaimal AJ, Little SE, Odibo AO, et al. Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Am J Obstet Gynecol 2011;204:137.e1-9. The full discussion appears at www.AJOG.org , pages e1-3.
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