Clinical and Population Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
BJOG. 2017 Mar;124(4):623-630. doi: 10.1111/1471-0528.14302. Epub 2016 Oct 21.
This study is an economic evaluation of immediate birth compared with expectant management in women with preterm prelabour rupture of the membranes near term (PPROMT).
A cost-effectiveness analysis alongside the PPROMT randomised controlled trial.
Obstetric departments in 65 hospitals across 11 countries.
Women with a singleton pregnancy with ruptured membranes between 34 and 36 weeks gestation.
Women were randomly allocated to immediate birth or expectant management. Costs to the health system were identified and valued. National hospital costing data from both the UK and Australia were used. Average cost per recruit in each arm was calculated and 95% confidence intervals were estimated using bootstrap re-sampling. Averages costs during antenatal care, delivery and postnatal care, and by country were estimated.
Total mean cost difference between immediate birth and expectant management arms of the trial.
From 11 countries 923 women were randomised to immediate birth and 912 were randomised to expectant management. Total mean costs per recruit were £8852 for immediate birth and £8740 for expectant delivery resulting in a mean difference in costs of £112 (95% CI: -431 to 662). The expectant management arm had significantly higher antenatal costs, whereas the immediate birth arm had significantly higher delivery and neonatal costs. There was large variation between total mean costs by country.
This economic evaluation found no evidence that expectant management was more or less costly than immediate birth. Outpatient management may offer opportunities for cost savings for those women with delayed delivery.
For women with preterm prelabour rupture of the membranes, the relative benefits and harms of immediate and expectant management should inform counselling as costs are similar.
本研究对临近足月（PPROMT）的胎膜早破孕妇进行即刻分娩与期待管理的经济学评价。
PPROMT 随机对照试验的成本效益分析。
11 个国家的 65 家医院的产科病房。
妊娠 34-36 周、胎膜早破的单胎孕妇。
将孕妇随机分为即刻分娩组或期待管理组。确定并评估卫生系统的成本。使用来自英国和澳大利亚的国家医院成本数据。计算每组每例患者的平均成本，并使用 bootstrap 重采样估计 95%置信区间。估计产前护理、分娩和产后护理期间以及各国的平均成本。
试验中即刻分娩组与期待管理组的总平均成本差异。
来自 11 个国家的 923 名孕妇被随机分配至即刻分娩组，912 名孕妇被随机分配至期待管理组。即刻分娩组的每位患者平均总费用为 8852 英镑，期待分娩组为 8740 英镑，成本差异的平均值为 112 英镑（95%CI：-431 至 662）。期待管理组的产前费用显著较高，而即刻分娩组的分娩和新生儿费用显著较高。各国之间的总平均成本存在很大差异。
本经济学评价未发现期待管理比即刻分娩更昂贵或更便宜的证据。对于那些分娩时间延迟的女性，门诊管理可能为节省成本提供机会。
对于胎膜早破的孕妇，即刻分娩与期待管理的相对获益和危害应告知咨询意见，因为成本相似。
