Epidural analgesia during labour, routinely or on request: a cost-effectiveness analysis

Area of Science:

• Obstetrics and Gynecology
• Health Economics
• Anesthesiology

Background:

• Epidural analgesia (EA) is a common pain management option during labor.
• The cost-effectiveness of routine EA versus on-request EA is not well-established.
• Societal perspective is crucial for comprehensive economic evaluations in healthcare.

Purpose of the Study:

• To compare the cost-effectiveness of routine labor epidural analgesia (EA) versus labor analgesia on request.
• To evaluate costs and effectiveness from a societal perspective.
• To inform clinical and policy decisions regarding labor pain management.

Main Methods:

• Randomized controlled trial in Dutch teaching hospitals.
• Inclusion criteria: singleton, cephalic presentation, >36 weeks gestation.
• Cost assessment: medical, non-medical, and indirect costs from randomization to 6 weeks postpartum.
• Effectiveness: non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects.
• Intention-to-treat analysis with base case and sensitivity analyses.

Main Results:

• Overall mean costs were comparable between routine EA (€8,708) and on-request analgesia (€8,710).
• Routine EA group had higher delivery costs but lower postpartum hospital costs (fewer neonatal admissions).
• Routine EA resulted in more operative deliveries and maternal adverse effects.
• Incremental cost-effectiveness ratio (ICER) was low (€8), but cost-effectiveness acceptability curve indicated low probability of routine EA being cost-effective.

Conclusions:

• Routine labor EA and analgesia on request generate comparable overall costs.
• Routine EA is associated with increased operative deliveries and maternal adverse effects.
• No preference for routine labor EA over analgesia on request can be made based on cost-effectiveness.