Obstetrics and Gynaecology, Clinical Sciences, University of Nottingham, Nottingham, UK.
Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
BJOG. 2017 May;124(6):929-934. doi: 10.1111/1471-0528.14557. Epub 2017 Mar 16.
Induction of labour at 39 weeks for nulliparous women aged 35 years and over may prevent stillbirths and does not increase caesarean births, so it may be popular. But the overall costs and benefits of such a policy have not been compared.
A cost-utility analysis alongside a randomised controlled trial (the 35/39 trial).
Obstetric departments of 38 UK National Health Service hospitals and one UK primary-care trust.
Nulliparous women aged 35 years or over on their expected due date, with a singleton live fetus in a cephalic presentation.
Costs were estimated from the National Health Service and Personal Social Services perspective and quality-adjusted life-years (QALYs) were calculated based on patient responses to the EQ-5D at baseline and 4 weeks.
Data on antenatal care, mode of delivery, analgesia in labour, method of induction, EQ-5D (baseline and 4 weeks postnatal) and participant-administered postnatal health resource use data were collected.
The intervention was associated with a mean cost saving of £263 and a small additional gain in QALYs (though this was not statistically significant), even without considering any possible QALY gains from stillbirth prevention.
A policy of induction of labour at 39 weeks for women of advanced maternal age would save money.
A policy of induction of labour at 39 weeks of gestation for women of advanced maternal age would save money.
对 35 岁及以上的初产妇在 39 周时引产可能会预防死产且不会增加剖宫产分娩，因此可能会受到欢迎。但这种政策的总体成本和效益尚未进行比较。
一项成本效用分析与随机对照试验（35/39 试验）同时进行。
38 家英国国民保健署医院和一个英国初级保健信托的产科部门。
预计分娩日期为 35 岁及以上的初产妇，胎儿为头位、单活胎。
从英国国家卫生服务和个人社会服务的角度估算成本，并根据患者在基线和 4 周时对 EQ-5D 的反应计算质量调整生命年（QALYs）。
收集了产前护理、分娩方式、分娩时镇痛、引产方法、EQ-5D（基线和产后 4 周）以及参与者管理的产后健康资源使用数据。
干预措施与节省 £263 的平均成本相关，并且 QALYs 略有增加（尽管这在统计学上并不显著），即使不考虑预防死产可能带来的任何 QALY 获益。
对高龄产妇进行 39 周引产的政策将节省资金。
