American journal of obstetrics & gynecology MFM · 2026
Cost effectiveness of outpatient balloon catheter induction of labor compared with inpatient prostaglandin: Economic analysis alongside the OBLIGE randomised controlled trial.
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Anderson Karyn, Wise Michelle, Sadler Lynn, Thompson John M D, Edlin Richard
Аннотация
BACKGROUND: Induction of labor is a common obstetric intervention. Numerous methods and protocols for achieving cervical ripening exist, including outpatient management using a balloon catheter.
OBJECTIVE (S): This study aims to perform a cost-effectiveness analysis of the OBLIGE trial, a multicentre randomised controlled trial comparing outpatient single balloon catheter for cervical ripening to inpatient vaginal prostaglandin (PG), using cesarean births avoided as the primary outcome measure.
STUDY DESIGN: Using a health service payer perspective, this cost-effectiveness analysis considers the direct healthcare costs (2021 NZ Dollars) from randomisation to 42 days post-birth. Clinical outcomes were identified from trial data collection, while healthcare resource use and costs were identified from routinely collected national data.
RESULTS: Across bootstraped replicates, the difference in mean costs -$256 (95% CI $-1172 to $639) and caesarean births avoided -5.67% (95% CI -11.09 to 0.07) did not reach statistical significance. These results suggest that balloon catheters may be considered cost-effective where decision makers value a cesarean birth avoided below $4,519. Subgroup analysis demonstrates outpatient balloon catheters are dominated (less effective and more costly) among parous women.
CONCLUSION (S): Immediate costs are unlikely to be critical in decisions about the use of outpatient balloon catheter induction of labor. In future economic analyses, consideration of longer-term costs and clinical outcomes resulting from cesarean birth, and any quality of life impacts of outpatient induction, would be important to clarify the cost-effectiveness of this intervention.
OBJECTIVE (S): This study aims to perform a cost-effectiveness analysis of the OBLIGE trial, a multicentre randomised controlled trial comparing outpatient single balloon catheter for cervical ripening to inpatient vaginal prostaglandin (PG), using cesarean births avoided as the primary outcome measure.
STUDY DESIGN: Using a health service payer perspective, this cost-effectiveness analysis considers the direct healthcare costs (2021 NZ Dollars) from randomisation to 42 days post-birth. Clinical outcomes were identified from trial data collection, while healthcare resource use and costs were identified from routinely collected national data.
RESULTS: Across bootstraped replicates, the difference in mean costs -$256 (95% CI $-1172 to $639) and caesarean births avoided -5.67% (95% CI -11.09 to 0.07) did not reach statistical significance. These results suggest that balloon catheters may be considered cost-effective where decision makers value a cesarean birth avoided below $4,519. Subgroup analysis demonstrates outpatient balloon catheters are dominated (less effective and more costly) among parous women.
CONCLUSION (S): Immediate costs are unlikely to be critical in decisions about the use of outpatient balloon catheter induction of labor. In future economic analyses, consideration of longer-term costs and clinical outcomes resulting from cesarean birth, and any quality of life impacts of outpatient induction, would be important to clarify the cost-effectiveness of this intervention.