41 孕周引产与期待管理及 42 孕周引产的成本效益分析。
Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: A cost-effectiveness analysis.
机构信息
Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
出版信息
BJOG. 2022 Dec;129(13):2157-2165. doi: 10.1111/1471-0528.16929. Epub 2021 Oct 12.
OBJECTIVE
To assess the cost-effectiveness of induction of labour (IOL) at 41 weeks of gestation compared with expectant management until 42 weeks of gestation.
DESIGN
A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial.
SETTING
Fourteen Swedish hospitals during 2016-2018.
POPULATION
Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41 weeks of gestation to IOL or to expectant management and induction at 42 weeks of gestation.
METHODS
Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping.
MAIN OUTCOME MEASURES
The cost per gained life year and per gained QALY.
RESULTS
The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was €4108 in the IOL group (n = 1373) and €4037 in the expectant management group (n = 1373), with a mean difference of €71 (95% CI -€232 to €379). The ICER for IOL compared with expectant management was €545 per life year gained and €623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes.
CONCLUSIONS
Induction of labour at 41 weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42 weeks of gestation using standard threshold values for acceptable cost per life year/QALY.
TWEETABLE ABSTRACT
Induction of labour at 41 weeks of gestation is cost-effective compared with expectant management until 42 weeks of gestation.
目的
评估 41 孕周引产（IOL）与 42 孕周期待管理相比的成本效益。
设计
瑞典过期妊娠诱导研究（SWEPIS）的成本效益分析，这是一项多中心、随机对照优效性试验。
地点
2016 年至 2018 年期间的 14 家瑞典医院。
人群
具有简单单胎妊娠和头位胎儿的女性在 41 孕周时随机分为 IOL 组或 42 孕周时期待管理和诱导组。
方法
通过母亲和儿童的生命年和质量调整生命年（QALY）来衡量健康效益。计算了每位产妇的总分娩成本，包括从随机分组到产后出院的母婴医疗保健费用。通过比较试验组之间的平均成本差异除以生命年和 QALY 的差异，计算出增量成本效益比（ICER）。使用非参数引导法评估抽样不确定性。
主要观察指标
每获得一个生命年和每获得一个 QALY 的成本。
结果
生命年和 QALY 获益的差异仅由围产期死亡率的差异驱动。死亡率的绝对风险降低为 0.004（从 6/1373 降至 0/1373）。根据瑞典生命表，这意味着每个分娩的预期寿命和 QALY 分别平均增加 0.14 和 0.12 年。IOL 组的每位产妇的平均分娩成本为 4108 欧元（n=1373），期待管理组为 4037 欧元（n=1373），平均差异为 71 欧元（95%CI -232 至 379）。与期待管理相比，IOL 的 ICER 为每获得一个生命年 545 欧元，每获得一个 QALY 623 欧元。置信区间相对较宽，包括 IOL 具有更低的成本和更好的健康结果的可能性。
结论
41 孕周时进行引产可获得更好的健康结果，且成本无显著差异。使用可接受的每生命年/QALY 成本标准阈值，IOL 与 42 孕周时的期待管理相比具有成本效益。
推文摘要
与 42 孕周期待管理相比，41 孕周引产具有成本效益。
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