Induction is one of the most common health care interventions in the United States, occurring in 23% of all deliveries. Elective induction is generally discouraged in nulliparous women because it was thought to increase cesarean delivery rates and hospital costs without appreciable maternal or neonatal benefit. These assumptions, however, have been challenged in recent years. The Eunice Kennedy Shriver National Institute of Child Health and Human Development?s Maternal-Fetal Medicine Units (MFMU) Network?s ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, a multicenter randomized trial of induction versus expectant management in nulliparous women at 39 weeks of gestation, provides a unique opportunity to measure a critical and understudied outcome: the cost of a common, expensive, and modifiable practice in healthcare. The objective of this proposed project is to assess the economic consequences of elective labor induction compared to expectant management at 39 weeks of gestation in low-risk pregnancies. We propose to measure the direct, itemized, comprehensive healthcare costs of induction and expectant management using advanced analytic tools for the approximately 1,300 patients projected to enroll in ARRIVE at the Utah MFMU study site. The results of the proposed study will supplement and elevate the influence of the ARRIVE trial by providing data that can inform value-based decisions and policies regarding elective induction. In addition, the proposed study, fostered by a multidisciplinary expert research team, will provide critical research skills in healthcare economic analytics for a promising clinician-scientist in the field of obstetrics.

Public Health Relevance

This proposed cost analysis of labor induction will use advanced analytics tools to measure the cost of elective labor induction at 39 weeks of gestation compared to expectant management. The detailed cost outcomes it produces will enhance the short term impact of the parent ARRIVE trial, and have long-lasting influence on the field of obstetrics by providing crucial and timely cost-effectiveness data to guide value-based policy decisions regarding labor induction, one of the field?s most common interventions.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Clinical Research Cooperative Agreements - Single Project (UG1)
Project #
3UG1HD034208-23S1
Application #
9370101
Study Section
Special Emphasis Panel (ZHD1)
Program Officer
Miodovnik, Menachem
Project Start
1996-05-01
Project End
2021-03-31
Budget Start
2017-04-01
Budget End
2018-03-31
Support Year
23
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of Utah
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
009095365
City
Salt Lake City
State
UT
Country
United States
Zip Code
84112
Clark, Erin A S; Weiner, Steven J; Rouse, Dwight J et al. (2018) Genetic Variation, Magnesium Sulfate Exposure, and Adverse Neurodevelopmental Outcomes Following Preterm Birth. Am J Perinatol 35:1012-1022
Pasko, Daniel N; McGee, Paula; Grobman, William A et al. (2018) Variation in the Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rate. Obstet Gynecol 131:1039-1048
Tita, Alan T; Doherty, Lindsay; Roberts, Jim M et al. (2018) Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial. Am J Perinatol 35:624-631
Tita, Alan T N; Jablonski, Kathleen A; Bailit, Jennifer L et al. (2018) Neonatal outcomes of elective early-term births after demonstrated fetal lung maturity. Am J Obstet Gynecol 219:296.e1-296.e8
Grobman, William A; Bailit, Jennifer; Sandoval, Grecio et al. (2018) The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes. Am J Perinatol 35:247-253
Saade, G R; Thom, E A; Grobman, W A et al. (2018) Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm. Ultrasound Obstet Gynecol 52:757-762
Chauhan, Suneet P; Weiner, Steven J; Saade, George R et al. (2018) Intrapartum Fetal Heart Rate Tracing Among Small-for-Gestational Age Compared With Appropriate-for-Gestational-Age Neonates. Obstet Gynecol 132:1019-1025
Kominiarek, Michelle A; Saade, George; Mele, Lisa et al. (2018) Association Between Gestational Weight Gain and Perinatal Outcomes. Obstet Gynecol 132:875-881
Grobman, William A; Bailit, Jennifer; Lai, Yinglei et al. (2018) Defining failed induction of labor. Am J Obstet Gynecol 218:122.e1-122.e8
Kominiarek, Michelle A; Smid, Marcela C; Mele, Lisa et al. (2018) Child Neurodevelopmental Outcomes by Prepregnancy Body Mass Index and Gestational Weight Gain. Obstet Gynecol 132:1386-1393

Showing the most recent 10 out of 153 publications