Academic Medical Centre, Amsterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2013 Oct;170(2):358-63. doi: 10.1016/j.ejogrb.2013.07.017. Epub 2013 Aug 1.
Pregnancies complicated by intrauterine growth restriction (IUGR) are at increased risk for neonatal morbidity and mortality. The Dutch nationwide disproportionate intrauterine growth intervention trial at term (DIGITAT trial) showed that induction of labour and expectant monitoring were comparable with respect to composite adverse neonatal outcome and operative delivery. In this study we compare the costs of both strategies.
A cost analysis was performed alongside the DIGITAT trial, which was a randomized controlled trial in which 650 women with a singleton pregnancy with suspected IUGR beyond 36 weeks of pregnancy were allocated to induction or expectant management. Resource utilization was documented by specific items in the case report forms. Unit costs for clinical resources were calculated from the financial reports of participating hospitals. For primary care costs Dutch standardized prices were used. All costs are presented in Euros converted to the year 2009.
Antepartum expectant monitoring generated more costs, mainly due to longer antepartum maternal stays in hospital. During delivery and the postpartum stage, induction generated more direct medical costs, due to longer stay in the labour room and longer duration of neonatal high care/medium care admissions. From a health care perspective, both strategies generated comparable costs: on average €7106 per patient for the induction group (N=321) and €6995 for the expectant management group (N=329) with a cost difference of €111 (95%CI: €-1296 to 1641).
Induction of labour and expectant monitoring in IUGR at term have comparable outcomes immediately after birth in terms of obstetrical outcomes, maternal quality of life and costs. Costs are lower, however, in the expectant monitoring group before 38 weeks of gestation and costs are lower in the induction of labour group after 38 weeks of gestation. So if induction of labour is considered to pre-empt possible stillbirth in suspected IUGR, it is reasonable to delay until 38 weeks, with watchful monitoring.
患有宫内生长受限（IUGR）的妊娠会增加新生儿发病率和死亡率的风险。荷兰全国范围内足月胎儿宫内生长干预试验（DIGITAT 试验）表明，引产和期待监测在复合不良新生儿结局和剖宫产方面具有可比性。在这项研究中，我们比较了这两种策略的成本。
这项成本分析是与 DIGITAT 试验同时进行的，这是一项随机对照试验，其中 650 名患有疑似 36 周以上妊娠的 IUGR 单胎妊娠的女性被分配到引产或期待管理组。资源利用情况通过病例报告表中的特定项目记录。临床资源的单位成本是根据参与医院的财务报告计算的。对于初级保健成本，使用了荷兰标准化价格。所有成本均以欧元表示，并转换为 2009 年的价格。
产前期待监测产生了更多的成本，主要是由于孕妇在医院的产前住院时间延长。在分娩和产后阶段，由于产妇在产房停留时间较长，新生儿需要入住高护理/中护理病房的时间较长，引产产生了更多的直接医疗费用。从医疗保健的角度来看，两种策略产生的成本相当：引产组（n=321）的每位患者平均为 7106 欧元，期待管理组（n=329）为 6995 欧元，差异为 111 欧元（95%CI：-1296 至 1641）。
在 IUGR 足月时，引产和期待监测在出生后立即的产科结局、产妇生活质量和成本方面具有可比性。然而，在 38 周前，期待监测组的成本较低，在 38 周后，引产组的成本较低。因此，如果考虑引产来预防疑似 IUGR 中的死产，那么在 38 周前进行期待监测是合理的。
