An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

G. J. van Baaren, K. Broekhuijsen, M. G. van Pampus, W. Ganzevoort, J. M. Sikkema, M. D. Woiski, M. A. Oudijk, K. W M Bloemenkamp, H. C J Scheepers, H. A. Bremer, R. J P Rijnders, A. J. van Loon, D. A M Perquin, J. M J Sporken, D. N M Papatsonis, M. E. van Huizen, C. B. Vredevoogd, J. T J Brons, M. Kaplan, A. H. van KaamH. Groen, M. Porath, P. P. van den Berg, B. W J Mol, M. T M Franssen, J. Langenveld, the HYPITAT-II Study Group

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6 Citations (Scopus)

Abstract

Objective: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. Design: A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). Setting: Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. Population: Women diagnosed with non-severe hypertensive disorders of pregnancy between 340/7 and 370/7 weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring. Methods: A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. Main outcome measures: Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge. Results: The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI −€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. Conclusion: In women with mild hypertensive disorders between 340/7 and 370/7 weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications. Tweetable abstract: Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery.

Original languageEnglish
Pages (from-to)453-461
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume124
Issue number3
DOIs
Publication statusPublished - 1 Feb 2017

Keywords

  • Economic evaluation
  • expectant monitoring
  • hypertensive disorders
  • immediate delivery
  • preterm

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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