Projects per year
Abstract
Objectives
To compare the clinical effectiveness and cost-effectiveness of labour induction methods.
Methods
We conducted a systematic review of randomised trials comparing interventions for third-trimester labour induction (search date: March 2014). Network meta-analysis was possible for six of nine prespecified key outcomes: vaginal delivery within 24 hours (VD24), caesarean section, uterine hyperstimulation, neonatal intensive care unit (NICU) admissions, instrumental delivery and infant Apgar scores. We developed a decision-tree model from a UK NHS perspective and calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit, and cost-effectiveness acceptability curves.
Main results
In all, 611 studies comparing 31 active interventions were included. Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 μg) were most likely to achieve VD24. Titrated low-dose oral misoprostol achieved the lowest odds of caesarean section, but there was considerable uncertainty in ranking estimates. Vaginal (≥50 μg) and buccal/sublingual misoprostol were most likely to increase uterine hyperstimulation with high uncertainty in ranking estimates. Compared with placebo, extra-amniotic prostaglandin E2 reduced NICU admissions. There were insufficient data to conduct analyses for maternal and neonatal mortality and serious morbidity or maternal satisfaction. Conclusions were robust after exclusion of studies at high risk of bias. Due to poor reporting of VD24, the cost-effectiveness analysis compared a subset of 20 interventions. There was considerable uncertainty in estimates, but buccal/sublingual and titrated (low-dose) misoprostol showed the highest probability of being most cost-effective.
Conclusions
Future trials should be designed and powered to detect a method that is more cost-effective than low-dose titrated oral misoprostol.
Tweetable abstract
New study ranks methods to induce labour in pregnant women on effectiveness and cost.
To compare the clinical effectiveness and cost-effectiveness of labour induction methods.
Methods
We conducted a systematic review of randomised trials comparing interventions for third-trimester labour induction (search date: March 2014). Network meta-analysis was possible for six of nine prespecified key outcomes: vaginal delivery within 24 hours (VD24), caesarean section, uterine hyperstimulation, neonatal intensive care unit (NICU) admissions, instrumental delivery and infant Apgar scores. We developed a decision-tree model from a UK NHS perspective and calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit, and cost-effectiveness acceptability curves.
Main results
In all, 611 studies comparing 31 active interventions were included. Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 μg) were most likely to achieve VD24. Titrated low-dose oral misoprostol achieved the lowest odds of caesarean section, but there was considerable uncertainty in ranking estimates. Vaginal (≥50 μg) and buccal/sublingual misoprostol were most likely to increase uterine hyperstimulation with high uncertainty in ranking estimates. Compared with placebo, extra-amniotic prostaglandin E2 reduced NICU admissions. There were insufficient data to conduct analyses for maternal and neonatal mortality and serious morbidity or maternal satisfaction. Conclusions were robust after exclusion of studies at high risk of bias. Due to poor reporting of VD24, the cost-effectiveness analysis compared a subset of 20 interventions. There was considerable uncertainty in estimates, but buccal/sublingual and titrated (low-dose) misoprostol showed the highest probability of being most cost-effective.
Conclusions
Future trials should be designed and powered to detect a method that is more cost-effective than low-dose titrated oral misoprostol.
Tweetable abstract
New study ranks methods to induce labour in pregnant women on effectiveness and cost.
| Original language | English |
|---|---|
| Pages (from-to) | 1462-1470 |
| Number of pages | 9 |
| Journal | BJOG: An International Journal of Obstetrics and Gynaecology |
| Volume | 123 |
| Issue number | 9 |
| Early online date | 22 Mar 2016 |
| DOIs | |
| Publication status | Published - Aug 2016 |
Keywords
- Comparative effectiveness research
- cost-effectiveness analysis
- labour induction
- network meta-analysis
- systematic review
Access to Document
- Full-text PDF (final published version)
© 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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- 3 Finished
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NIRG: Bayesian evidence synthesis of multiple outcomes
Welton, N. J. (Principal Investigator)
1/01/15 → 30/09/18
Project: Research
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Advancing women's health through evidence
Dias, S. (Speaker)
1 Apr 2016 → 3 Apr 2016Activity: Participating in or organising an event types › Invited talk
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RSS international conference 2015
Dias, S. (Invited speaker)
7 Sept 2015 → 10 Sept 2015Activity: Participating in or organising an event types › Participation in conference