Outpatient Foley Catheter for Cervical Ripening in Low-Risk Women: A Cost-Effectiveness Analysis [24P

Abstract

INTRODUCTION: Based on research literature there appears to be a significant benefit to induction of labor (IOL) in nulliparous patients. A recent meta-analysis of the Foley catheter for pre-induction of labor cervical ripening in the outpatient setting concluded that the risk of adverse events is low (0.0–0.26%). We sought to investigate the cost effectiveness of Foley catheter use for pre-induction cervical ripening in an outpatient versus inpatient setting in low-risk women. METHODS: We created a decision-analytic model using TreeAge Pro software assessing the cost-effectiveness and outcomes associated with pre-induction cervical ripening using Foley catheter in an outpatient versus inpatient setting. We estimated a theoretical cohort of 760,000 low-risk nulliparous women with an unfavorable cervix at term. 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. RESULTS: In a theoretical cohort of 760,000 women undergoing pre-induction cervical ripening by Foley catheter, we found that outpatient Foley was the dominant strategy, meaning it was lower in cost and higher in effectiveness. There were fewer cesareans in the outpatient group primarily due to a lower rate of failed induction. However, there were 16 stillbirths in the outpatient cohort. Our results were robust over a wide range of assumptions. CONCLUSION: We found outpatient Foley catheter to be a cost-effective option for pre-induction cervical ripening in low-risk women at term and should be considered for such women undergoing scheduled induction of labor.