Is induction of labour at term a cost-effective option for nulliparous women over 35?

We will discuss Labour induction near term for women aged 35 or over: an economic evaluation by Walker and coauthors on the 29th March 2017This paper is free to view from 20th March.

Start date: 29 March 2017. The discussion will continue for 7 days until 5th April 2017.

First hosted discussion session(s) on Twitter starts at BST 8pm (3pm EST/12 noon PST) on 29 March 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are below:

Scenario

Recent evidence has suggested that there may be some benefit in inducing nulliparous women at 39 weeks if they are 35 years of age or older.  Do you think your health system should change to a policy of offering this routinely?

Description of Research:

Participants 380 nulliparous women aged 35 years or older with an ongoing singleton pregnancy at 39 weeks, with the fetus in cephalic position.

Women were excluded if they had any contraindication to labour, vaginal delivery or expectant management; if they had known fetal abnormality; if they had not had an ultrasound before 22 weeks (no anomaly scan); or if they had undergone IVF with the use of donor eggs.

Intervention Induction between 39+0 and 39+6 weeks of gestation.
Comparison Expectant management of pregnancy.
Outcomes Resource utilization was captured through routine health service data collection, verified by reseach staff, and patient questionnaires at one month postnatal.
Study design Cost-utility analysis: secondary economic analysis of subset of paricipants in a randomised controlled trial.

Discussion Points:

  • How do you currently manage a woman aged 35 or over in her first pregnancy?
  • Why measure economic outcomes? What is the difference between economic outcomes and a cost-utility analysis?
  • Healthcare spending is not normally distributed, as a small number of people will have very high costs. What steps did the researchers take to mitigate this? Are these adequate?
  • What is a Quality Adjusted Life Year (QALY)?
  • A prospective economic evaluation of the intervention (induction for primparous mothers over 35 at 39 weeks) was embedded into the trial design. How did the authors do this?
  • This study was conducted from the perspective of the NHS in England, which is a universal coverage system that is free at the point of need. How might this translate to another healthcare system (your own, if not in the UK?
  • Can you briefly summarise the results of this study? How would the results of this study influence your practice?

Suggested reading

National Institute of Care Excellence. Guide to Methods of Technology Appraisal, 2013.

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