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Cost-Effectiveness Analysis of Latent versus Active Labor Hospital Admission for Medically Low-Risk, Term Women

机译：医疗低风险，足月妇女的潜伏期住院与主动劳动医院入院的成本-效果分析

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Objective: To assess the outcomes and costs of hospital admission during the latent versus active phase of labor. Latent labor hospital admission has been consistently associated with elevated maternal risk for increased interventions, including epidural anesthesia and cesarean delivery, longer hospital stay, and higher utilization of hospital resources. Methods: A cost-effectiveness model was built to simulate a theoretic cohort of 3.2 million term, medically low-risk women either being admitted in latent labor (<4cm dilation) or delaying admission until active labor (4cm dilation). Outcomes included epidural use, mode of delivery, stillbirth, maternal death, and costs of care. All probability, cost, and utility estimates were derived from the literature, and total quality-adjusted life years were calculated. Sensitivity analyses and a Monte Carlo simulation were used to investigate the robustness of model assumptions. Results: Delaying admission until active labor would result in 672,000 fewer epidurals, 67,232 fewer cesarean deliveries, and 9.6 fewer maternal deaths in our theoretic cohort as compared to admission during latent labor. Additionally, delaying admission results in a cost savings of $694 million annually in the United States. Sensitivity analyses indicated the model was robust within a wide range of probabilities and costs. Monte Carlo simulation found that delayed admission was the optimal strategy in 76.79 percent of trials. Conclusion: Delaying admission until active labor is a dominant strategy, resulting in both better outcomes and lower costs. Issues related to clinical translation of these findings are explored.
机译：目的：评估潜伏期和活跃期的入院结果和费用。潜伏医院入院一直与增加干预措施的产妇风险增加相关，包括硬膜外麻醉和剖宫产，更长的住院时间和更高的医院资源利用率。方法：建立了成本效益模型来模拟320万个学期的理论队列，医学上低风险的妇女要么接受潜伏劳动（<4cm扩张），要么推迟入院直至积极劳动（4cm扩张）。结果包括硬膜外使用，分娩方式，死产，产妇死亡和护理费用。所有概率，成本和效用估计值均来自文献，并计算了总质量调整生命年。敏感性分析和蒙特卡洛模拟用于研究模型假设的鲁棒性。结果：与进行潜在分娩相比，推迟入院直到积极分娩将导致我们的理论队列中的硬膜外麻醉减少672,000例，剖宫产减少67,232例，孕产妇死亡减少9.6例。此外，在美国，延误入学每年可节省6.94亿美元的成本。敏感性分析表明，该模型在各种概率和成本范围内都很鲁棒。蒙特卡洛模拟发现延迟入院是76.79％的试验中的最佳策略。结论：延迟入院直到积极的分娩是主要策略，这既带来了更好的结果，又降低了成本。探索与这些发现的临床翻译有关的问题。

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