1075 Outpatient cervical ripening with foley catheter in low-risk women: a cost-effectiveness analysis

Abstract

Based on the ARRIVE trial and a recent meta-analysis there appears to be a significant benefit to induction of labor (IOL) in nulliparous patients. This led to recommendations from SMFM and ACOG which will likely dramatically increase the number of IOL’s in women, especially with unfavorable cervices. We sought to investigate if outpatient cervical ripening with a Foley catheter is cost effective versus inpatient setting in low-risk women. A decision-analytic model using TreeAge Pro software was developed with a theoretical cohort of 760,000 low-risk nulliparous women at term to assess the cost-effectiveness and outcomes associated with cervical ripening using Foley catheter in an outpatient versus inpatient setting. Outcomes included cesarean delivery, postpartum hemorrhage, maternal death, infant death and stillbirth, in addition to cost and quality-adjusted life years (QALYs) for both the woman and the neonate. A willingness-to-pay threshold was set at $100,000/QALY. In a theoretical cohort of 760,000 women undergoing cervical ripening by Foley catheter, we found there were 87,251 fewer cesarean deliveries which led to 1,920 fewer postpartum hemorrhages in the outpatient group primarily due to a lower rate of failed induction. However, there were 16 stillbirths in the outpatient cohort. Outpatient was the dominant strategy, meaning it was lower in cost and higher in effectiveness. Our results were robust over a wide range of assumptions. We found outpatient Foley catheter to be a cost-effective option for pre-induction cervical ripening in low-risk women at term. These results suggest outpatient Foley ripening should be considered for such women undergoing scheduled induction of labor.View Large Image Figure ViewerDownload Hi-res image Download (PPT)