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Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.

Z Alfirevic1, E Keeney2, T Dowswell1

  • 1Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.

BJOG : an International Journal of Obstetrics and Gynaecology
|March 23, 2016
PubMed
Summary
This summary is machine-generated.

This study compared labor induction methods for pregnant women. Titrated low-dose oral misoprostol appears most cost-effective, though more research is needed to confirm optimal methods.

Keywords:
Comparative effectiveness researchcost-effectiveness analysislabour inductionnetwork meta-analysissystematic review

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Area of Science:

  • Obstetrics and Gynecology
  • Pharmacoeconomics
  • Evidence-Based Medicine

Background:

  • Labor induction is a common obstetric intervention.
  • Various methods exist for inducing labor, each with potential benefits and risks.
  • Comparing the clinical effectiveness and cost-effectiveness of these methods is crucial for optimizing maternal and neonatal outcomes.

Purpose of the Study:

  • To systematically review and compare the clinical effectiveness of different labor induction methods.
  • To evaluate the cost-effectiveness of various labor induction interventions from a UK National Health Service (NHS) perspective.
  • To identify the most effective and cost-effective methods for inducing labor in pregnant women.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) published up to March 2014 was conducted.
  • Network meta-analysis was performed for key outcomes including vaginal delivery within 24 hours (VD24), caesarean section, and neonatal intensive care unit (NICU) admissions.
  • A decision-tree model was developed to assess cost-effectiveness, calculating incremental cost-effectiveness ratios and net benefit.

Main Results:

  • Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 mcg) were most effective for achieving VD24.
  • Titrated low-dose oral misoprostol demonstrated the lowest odds of caesarean section.
  • Buccal/sublingual and titrated low-dose oral misoprostol showed the highest probability of being most cost-effective, despite considerable uncertainty in ranking estimates.

Conclusions:

  • Low-dose titrated oral misoprostol is a promising cost-effective method for labor induction.
  • Future research should focus on designing trials powered to confirm the cost-effectiveness of labor induction methods.
  • Further investigation is needed to address data gaps regarding maternal and neonatal mortality and morbidity.