Goeree R, Hannah M, Hewson S
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
CMAJ. 1995 May 1;152(9):1445-50.
To determine the cost-effectiveness of induction of labour versus serial fetal monitoring while awaiting spontaneous labour in postterm pregnancies.
Cost-effectiveness and cost-minimization analyses conducted as part of a Canadian multicentre randomized clinical trial.
Twenty-two Canadian hospitals, of which 19 were teaching hospitals and 3 were community hospitals.
Women with uncomplicated pregnancies of 41 or more weeks' gestation were randomly assigned to induction of labour or serial antenatal monitoring. Of the 3418 women enrolled, no data were received on 11. Therefore, results were based on data from 1701 women in the induction arm of the study and 1706 women in the monitoring arm.
Perinatal mortality and neonatal morbidity, rates of cesarean section and health care costs. Hospital costing models were developed specifically for the study. Data on use of major resources (e.g., length of hospital stay, surgical procedures, major diagnostic tests and procedures, and medications) for all trial participants were collected and combined with data on minor tests and procedures (e.g., laboratory tests) abstracted from a detailed review of medical records of a sample of patients.
Because the results of the clinical trial showed a nonsignificant difference in perinatal mortality and neonatal morbidity between the induction and monitoring arms, the authors conducted a cost-minimization rather than a cost-effectiveness analysis. The mean cost per patient with a postterm pregnancy managed through monitoring was $3132 (95% confidence interval [CI] $3090 to $3174) and per patient who underwent induction of labour was $2939 (95% CI $2898 to $2981), for a difference of $193. The significantly higher (p < 0.0001) mean cost per patient in the monitoring arm was due mainly to the costs of additional monitoring and the significantly higher rates of cesarean section among these patients. Estimated conservatively, the savings resulting from a universal policy of managing postterm pregnancies by induction of labour in Canada may be as high as $8 million a year.
A policy of managing postterm pregnancy through induction of labour not only results in more favourable outcomes than a monitoring strategy but does so at a lower cost.
确定过期妊娠时引产与连续胎儿监护等待自然分娩相比的成本效益。
作为加拿大一项多中心随机临床试验的一部分进行成本效益和成本最小化分析。
22家加拿大医院，其中19家为教学医院，3家为社区医院。
妊娠41周及以上且无并发症的孕妇被随机分配至引产组或连续产前监护组。在纳入的3418名女性中，未收到11名患者的数据。因此，结果基于研究引产组的1701名女性和监护组的1706名女性的数据。
围产儿死亡率和新生儿发病率、剖宫产率及医疗保健成本。专门为该研究建立了医院成本模型。收集了所有试验参与者使用主要资源（如住院时间、外科手术、主要诊断检查和程序以及药物）的数据，并与从部分患者病历详细审查中提取的次要检查和程序（如实验室检查）数据相结合。
由于临床试验结果显示引产组和监护组在围产儿死亡率和新生儿发病率方面无显著差异，作者进行了成本最小化分析而非成本效益分析。通过监护管理的过期妊娠患者平均每人成本为3132美元（95%置信区间[CI]3090美元至3174美元），引产患者平均每人成本为2939美元（95%CI2898美元至2981美元），相差193美元。监护组患者平均每人成本显著更高（p<0.0001），主要是由于额外监护成本以及这些患者中剖宫产率显著更高。保守估计，加拿大通过引产管理过期妊娠的普遍政策每年可节省高达800万美元。
通过引产管理过期妊娠的政策不仅比监护策略能带来更有利的结果，而且成本更低。
