Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Am J Obstet Gynecol. 2011 Feb;204(2):137.e1-9. doi: 10.1016/j.ajog.2010.08.012. Epub 2010 Oct 20.
To investigate the cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women.
A decision analytic model comparing induction of labor at 41 weeks vs expectant management with antenatal testing until 42 weeks in nulliparas was designed. Baseline assumptions were derived from the literature as well as from analysis of the National Birth Cohort dataset and included an intrauterine fetal demise rate of 0.12% in the 41st week and a cesarean rate of 27% in women induced at 41 weeks. One-way and multiway sensitivity analyses were conducted to examine the robustness of the findings.
Compared with expectant management, induction of labor is cost-effective with an incremental cost of $10,945 per quality-adjusted life year gained. Induction of labor at 41 weeks also resulted in a lower rate of adverse obstetric outcomes, including neonatal demise, shoulder dystocia, meconium aspiration syndrome, and severe perineal lacerations.
Elective induction of labor at 41 weeks is cost-effective and improves outcomes.
探讨初产妇 41 周选择性引产的成本效益。
设计了一个决策分析模型，比较了初产妇在 41 周时引产与在 42 周前进行产前检查的期待管理。基线假设来自文献以及对国家出生队列数据集的分析，包括第 41 周时宫内胎儿死亡率为 0.12%，41 周时行引产的剖宫产率为 27%。进行了单因素和多因素敏感性分析，以检查研究结果的稳健性。
与期待管理相比，引产具有成本效益，每获得 1 个质量调整生命年的增量成本为 10945 美元。41 周时引产还可降低不良产科结局的发生率，包括新生儿死亡、肩难产、胎粪吸入综合征和严重会阴裂伤。
41 周时选择性引产具有成本效益，并可改善结局。
