Comparing induction of labour with oral misoprostol or Foley catheter at term: cost-effectiveness analysis of a randomised controlled multi-centre non-inferiority trial

ObjectiveTo assess the costs of labour induction with oral misoprostol versus Foley catheter. DesignEconomic evaluation alongside a randomised controlled trial. SettingObstetric departments of six tertiary and 23 secondary care hospitals in the Netherlands. PopulationWomen with a viable term singleton pregnancy in cephalic presentation, intact membranes, an unfavourable cervix (Bishop score <6) without a previous caesarean section, were randomised for labour induction with oral misoprostol (n = 924) or Foley catheter (n = 921). MethodsWe performed economic analysis from a hospital perspective. We estimated direct medical costs associated with healthcare utilisation from randomisation until discharge. The robustness of our findings was evaluated in sensitivity analyses. Main outcome measuresMean costs and differences were calculated per women induced with oral misoprostol or Foley catheter. ResultsMean costs per woman in the oral misoprostol group and Foley catheter group were Euro4470 versus Euro4158, respectively [mean difference Euro312, 95% confidence interval (CI) -Euro508 to Euro1063]. Multiple sensitivity analyses did not change these conclusions. However, if cervical ripening for low-risk pregnancies in the Foley catheter group was carried out in an outpatient setting, with admittance to labour ward only at start of active labour, the difference would be Euro4470 versus Euro3489, respectively (mean difference Euro981, 95% CI Euro225-1817). ConclusionsOral misoprostol and Foley catheter generate comparable costs. Cervical ripening outside labour ward with a Foley catheter could potentially save almost Euro1000 per woman. Tweetable abstractOral misoprostol or Foley catheter for induction of labour generates comparable costs. Tweetable abstract Oral misoprostol or Foley catheter for induction of labour generates comparable costs.