870: Economic analysis of induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial ISRCTN29313500)

Abstract

Preterm prelabor rupture of membranes (PPROM) is an important clinical problem. Awaiting spontaneous labor may lead to an increase in infectious disease for mother and child, whereas induction of labor leads to preterm birth with an increase in neonatal morbidity. The Dutch nationwide preterm prelabor rupture of the membranestrial (Ppromexil trial) was initiated. Our aim was to perform an economic analysis alongside the trial. In the PPROMEXIL trial pregnant non-laboring women with PPROM for more than 24 hours at a gestational age from 34+0/7 week to 37+0/7 weeks were randomly allocated to either induction of labor or expectant management. We performed an economic analysis alongside the trial, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs. Bootstrap analysis was used to estimate 95% confidence intervals around the mean costs and differences. All costs are presented in 2007 Euros. The economic analysis was performed from a health care provider perspective. A total of 536 women were randomized of which 268 were allocated to induction of labor and 268 to expectant management. Mean costs per patient were € 7.982 for induction and € 7.351 for expectant management (difference € 631; 95% CI - 579 to 1.991). This difference predominantly originated in the postpartum period: per patient € 5.756 for induction versus € 4.855 for expectant management due to longer duration of neonatal HC/MC admissions. Delivery costs were higher in patients allocated to induction than in patients allocated to expectant group (€1.599 versus €1.165 per patient), because of longer duration in the labor room or operation theatre. Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. Women with pregnancies complicated by PPROM near term, induction of labor and expectant management generate comparable costs.