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.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Clinical Research Cooperative Agreements - Single Project (UG1)
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Application #
Study Section
Special Emphasis Panel (ZHD1)
Program Officer
Miodovnik, Menachem
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University of Utah
Obstetrics & Gynecology
Schools of Medicine
Salt Lake City
United States
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