Outpatient Cervical Ripening: A Cost-Minimization and Threshold Analysis

Area of Science:

• Obstetrics and Gynecology
• Health Economics
• Maternal-Fetal Medicine

Background:

• Cervical ripening is a common procedure in term pregnancies with unfavorable cervices.
• Transcervical balloons are a method for cervical ripening.
• The cost-effectiveness of outpatient versus inpatient cervical ripening requires evaluation.

Purpose of the Study:

• To compare the costs of outpatient (OP) versus inpatient (IP) cervical ripening using transcervical balloons.
• To identify conditions under which each ripening strategy is cost-saving.

Main Methods:

• A decision model was developed to compare OP and IP balloon ripening for term singleton pregnancies with unfavorable cervices.
• A cost-minimization analysis and threshold analyses were conducted from a health system perspective.
• Data on probability, utilization, and cost were sourced from existing literature, with sensitivity analyses performed.

Main Results:

• Both OP ripening strategies proved cost-saving compared to IP ripening, with savings of -$228.40/patient (broad use) and -$73.48/patient (limited use).
• OP ripening remained cost-saving unless labor and delivery (L&D) hours saved were less than 3.5, insertion visit costs exceeded $714, or facility costs/hour on L&D were below $61.
• Sensitivity analyses indicated that OP ripening is cost-saving under most plausible clinical scenarios.

Conclusions:

• Outpatient transcervical balloon ripening is a cost-saving approach for patients with unfavorable cervices.
• The cost-effectiveness is particularly pronounced when OP ripening reduces L&D time by at least 3.5 hours.