Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E2 gel (PROBAAT trial)

Gj Van Baaren, M. Jozwiak, B. C. Opmeer, K. Oude Rengerink, M. Benthem, M. G K Dijksterhuis, M. E. Van Huizen, P. C M Van Der Salm, N. W E Schuitemaker, D. N M Papatsonis, D. A M Perquin, M. Porath, J. A M Van Der Post, R. J P Rijnders, H. C J Scheepers, M. Spaanderman, M. G. Van Pampus, J. W. De Leeuw, B. W J Mol, K. W M Bloemenkamp

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Objective To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 gel. Design Economic evaluation alongside a randomised controlled trial. Setting Obstetric departments of one university and 11 teaching hospitals in the Netherlands. Population Women scheduled for labour induction with a singleton pregnancy in cephalic presentation at term, intact membranes and an unfavourable cervix; and without previous caesarean section. Methods Cost-effectiveness analysis from a hospital perspective. Main outcome measures We estimated direct medical costs associated with healthcare utilisation from randomisation to 6 weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental cost-effectiveness ratios, which represent the costs to prevent one of these adverse outcomes. Results Mean costs per woman in the Foley catheter group (n = 411) and in the prostaglandin E2 gel group (n = 408), were €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval -€157 to €633). In the Foley catheter group we observed higher costs due to longer labour ward occupation and less cost related to induction material and neonatal admissions. Foley catheter induction showed a comparable caesarean section rate compared with prostaglandin induction, therefore the incremental cost-effectiveness ratio was not informative. Foley induction resulted in fewer neonatal admissions (incremental cost-effectiveness ratio €2708) and asphyxia/postpartum haemorrhage (incremental cost-effectiveness ratios €5257) compared with prostaglandin induction. Conclusions Foley catheter and prostaglandin E 2 labour induction generate comparable costs.

Original languageEnglish
Pages (from-to)987-995
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number8
Publication statusPublished - 1 Jul 2013


  • Cost-effectiveness
  • Foley catheter
  • induction of labour
  • prostaglandin
  • randomised controlled trial

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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