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

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Leigh, Simon, Granby, Paul, Haycox, Alan, Mundle, Shuchita, Bracken, Hillary, Khedikar, Vaishali, Mulik, Jayashree, Faragher, Brian, Easterling, Thomas, Turner, Mark A, Alfirevic, Zarko, Winikoff, Beverly and Weeks, Andrew D (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 & Gynaecology.

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Abstract

OBJECTIVE
To determine the effectiveness and economic impact of two methods for induction of labour in hypertensive women, in low-resource settings.
DESIGN
Cost-consequence analysis of a previously reported multi-centre, parallel, open-label randomized trial.
SETTING & POPULATION
602 women with a live fetus, aged>18 years requiring delivery for pre-eclampsia or hypertension, in two public hospitals in Nagpur, India.
METHODS
We performed a formal economic evaluation alongside the INFORM clinical trial. Women were randomised to receive transcervical Foley catheterisation or oral misoprostol 25mcg. Healthcare expenditure was calculated using a provider-side micro-costing approach.
MAIN OUTCOME MEASURES
Rates of vaginal delivery within 24hours of induction, healthcare-expenditure per completed treatment episode.
RESULTS
Induction with oral misoprostol resulted in lower healthcare expenditure, mean difference (-)$20.6USD [95%CI ((-)$12.73USD-(-)26.74USD)], and improved achievement of vaginal delivery within 24hours of induction, mean difference 10% [95%CI (-2%-17.9%), p=0.016)]. Oxytocin administration time was reduced by 135.3minutes [95%CI (84.4-186.2mins), p<0.01), and Caesarean sections by 9.1% [95%CI (1.1%-17%), p=0.025)] for those receiving oral misoprostol. Following probabilistic sensitivity analysis, oral misoprostol was cost saving in 63% of 5,000 bootstrap replications and achieved superior rates of delivery within 24 hours of induction, vaginal delivery, and vaginal delivery within 24 hours of induction in 90.7%, 98.7% and 99.4% of bootstrap simulations. Based on univariate threshold analysis, the unit price of oral misoprostol 25mcg could feasibly increase 31-fold from $0.24 to $7.50 per 25mcg tablet and remain cost saving.
CONCLUSION
Compared to Foley catheterisation for the induction of high-risk hypertensive women, oral misoprostol improves rates of vaginal delivery within 24h of induction and may also reduce costs. Additional research performed in other low-resource settings is required to determine their relative cost-effectiveness. This article is protected by copyright. All rights reserved.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
QV Pharmacology > Cardiovascular Agents. Renal Agents > QV 150 Cardiovascular agents
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WG Cardiovascular System > WG 100 General works
WQ Obstetrics > Labor > WQ 300 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1111/1471-0528.15285
Depositing User: Stacy Murtagh
Date Deposited: 25 May 2018 14:44
Last Modified: 28 Jun 2018 08:28
URI: https://archive.lstmed.ac.uk/id/eprint/8682

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