An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

G-J van Baaren; K. Broekhuijsen; M. G. van Pampus; W. Ganzevoort; J. M. Sikkema; M. D. Woiski; M. A. Oudijk; K. W. M. Bloemenkamp; H. C. J. Scheepers; H. A. Bremer; R. J. P. Rijnders; A. J. van Loon; D. A. M. Perquin; J. M. J. Sporken; D. N. M. Papatsonis; M. E. van Huizen; C. B. Vredevoogd; J. T. J. Brons; M. Kaplan; A. H. van Kaam; H. Groen; M. Porath; P. P. van den Berg; B. W. J. Mol; M. T. M. Franssen; J. Langenveld; HYPITAT-II Study Grp

doi:10.1111/1471-0528.13957

An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

G-J van Baaren^*, K. Broekhuijsen, M. G. van Pampus, W. Ganzevoort, J. M. Sikkema, M. D. Woiski, M. A. Oudijk, K. W. M. Bloemenkamp, H. C. J. Scheepers, H. A. Bremer, R. J. P. Rijnders, A. J. van Loon, D. A. M. Perquin, J. M. J. Sporken, D. N. M. Papatsonis, M. E. van Huizen, C. B. Vredevoogd, J. T. J. Brons, M. Kaplan, A. H. van KaamH. Groen, M. Porath, P. P. van den Berg, B. W. J. Mol, M. T. M. Franssen, J. Langenveld, HYPITAT-II Study Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.

Design A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).

Setting Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.

Population Women diagnosed with non-severe hypertensive disorders of pregnancy between 34(0/7) and 37(0/7) weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring.

Methods A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge.

Main outcome measures Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge.

Results The average costs of immediate delivery (n = 352) were (sic)10 245 versus (sic)9563 for expectant monitoring (n = 351), with an average difference of (sic)682 (95% confidence interval, 95% CI -(sic)618 to (sic)2126). This 7% difference predominantly originated from the neonatal admissions, which were (sic)5672 in the immediate delivery arm and (sic)3929 in the expectant monitoring arm.

Conclusion In women with mild hypertensive disorders between 34(0/7) and 37(0/7) weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications.

Original language	English
Pages (from-to)	453-461
Number of pages	9
Journal	Bjog-an International Journal of Obstetrics and Gynaecology
Volume	124
Issue number	3
DOIs	https://doi.org/10.1111/1471-0528.13957
Publication status	Published - Feb 2017

Keywords

Economic evaluation
expectant monitoring
hypertensive disorders
immediate delivery
preterm
COST-EFFECTIVENESS
PREECLAMPSIA
INDUCTION
TRIAL
LABOR
TERM
ECLAMPSIA

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10.1111/1471-0528.13957

Cite this

van Baaren, G.-J., Broekhuijsen, K., van Pampus, M. G., Ganzevoort, W., Sikkema, J. M., Woiski, M. D., Oudijk, M. A., Bloemenkamp, K. W. M., Scheepers, H. C. J., Bremer, H. A., Rijnders, R. J. P., van Loon, A. J., Perquin, D. A. M., Sporken, J. M. J., Papatsonis, D. N. M., van Huizen, M. E., Vredevoogd, C. B., Brons, J. T. J., Kaplan, M., ... HYPITAT-II Study Grp (2017). An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II). Bjog-an International Journal of Obstetrics and Gynaecology, 124(3), 453-461. https://doi.org/10.1111/1471-0528.13957

@article{bf908d3042d84cd3bfce95b912858a41,

title = "An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)",

abstract = "Objective To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.Design A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).Setting Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.Population Women diagnosed with non-severe hypertensive disorders of pregnancy between 34(0/7) and 37(0/7) weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring.Methods A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge.Main outcome measures Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge.Results The average costs of immediate delivery (n = 352) were (sic)10 245 versus (sic)9563 for expectant monitoring (n = 351), with an average difference of (sic)682 (95% confidence interval, 95% CI -(sic)618 to (sic)2126). This 7% difference predominantly originated from the neonatal admissions, which were (sic)5672 in the immediate delivery arm and (sic)3929 in the expectant monitoring arm.Conclusion In women with mild hypertensive disorders between 34(0/7) and 37(0/7) weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications.",

keywords = "Economic evaluation, expectant monitoring, hypertensive disorders, immediate delivery, preterm, COST-EFFECTIVENESS, PREECLAMPSIA, INDUCTION, TRIAL, LABOR, TERM, ECLAMPSIA",

author = "{van Baaren}, G-J and K. Broekhuijsen and {van Pampus}, {M. G.} and W. Ganzevoort and Sikkema, {J. M.} and Woiski, {M. D.} and Oudijk, {M. A.} and Bloemenkamp, {K. W. M.} and Scheepers, {H. C. J.} and Bremer, {H. A.} and Rijnders, {R. J. P.} and {van Loon}, {A. J.} and Perquin, {D. A. M.} and Sporken, {J. M. J.} and Papatsonis, {D. N. M.} and {van Huizen}, {M. E.} and Vredevoogd, {C. B.} and Brons, {J. T. J.} and M. Kaplan and {van Kaam}, {A. H.} and H. Groen and M. Porath and {van den Berg}, {P. P.} and Mol, {B. W. J.} and Franssen, {M. T. M.} and J. Langenveld and {HYPITAT-II Study Grp}",

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language = "English",

volume = "124",

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journal = "Bjog-an International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

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van Baaren, G-J, Broekhuijsen, K, van Pampus, MG, Ganzevoort, W, Sikkema, JM, Woiski, MD, Oudijk, MA, Bloemenkamp, KWM, Scheepers, HCJ, Bremer, HA, Rijnders, RJP, van Loon, AJ, Perquin, DAM, Sporken, JMJ, Papatsonis, DNM, van Huizen, ME, Vredevoogd, CB, Brons, JTJ, Kaplan, M, van Kaam, AH, Groen, H, Porath, M, van den Berg, PP, Mol, BWJ, Franssen, MTM, Langenveld, J & HYPITAT-II Study Grp 2017, 'An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)', Bjog-an International Journal of Obstetrics and Gynaecology, vol. 124, no. 3, pp. 453-461. https://doi.org/10.1111/1471-0528.13957

An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II). / van Baaren, G-J; Broekhuijsen, K.; van Pampus, M. G. et al.
In: Bjog-an International Journal of Obstetrics and Gynaecology, Vol. 124, No. 3, 02.2017, p. 453-461.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

AU - van Baaren, G-J

AU - Broekhuijsen, K.

AU - van Pampus, M. G.

AU - Ganzevoort, W.

AU - Sikkema, J. M.

AU - Woiski, M. D.

AU - Oudijk, M. A.

AU - Bloemenkamp, K. W. M.

AU - Scheepers, H. C. J.

AU - Bremer, H. A.

AU - Rijnders, R. J. P.

AU - van Loon, A. J.

AU - Perquin, D. A. M.

AU - Sporken, J. M. J.

AU - Papatsonis, D. N. M.

AU - van Huizen, M. E.

AU - Vredevoogd, C. B.

AU - Brons, J. T. J.

AU - Kaplan, M.

AU - van Kaam, A. H.

AU - Groen, H.

AU - Porath, M.

AU - van den Berg, P. P.

AU - Mol, B. W. J.

AU - Franssen, M. T. M.

AU - Langenveld, J.

AU - HYPITAT-II Study Grp

PY - 2017/2

Y1 - 2017/2

N2 - Objective To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.Design A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).Setting Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.Population Women diagnosed with non-severe hypertensive disorders of pregnancy between 34(0/7) and 37(0/7) weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring.Methods A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge.Main outcome measures Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge.Results The average costs of immediate delivery (n = 352) were (sic)10 245 versus (sic)9563 for expectant monitoring (n = 351), with an average difference of (sic)682 (95% confidence interval, 95% CI -(sic)618 to (sic)2126). This 7% difference predominantly originated from the neonatal admissions, which were (sic)5672 in the immediate delivery arm and (sic)3929 in the expectant monitoring arm.Conclusion In women with mild hypertensive disorders between 34(0/7) and 37(0/7) weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications.

AB - Objective To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.Design A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).Setting Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.Population Women diagnosed with non-severe hypertensive disorders of pregnancy between 34(0/7) and 37(0/7) weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring.Methods A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge.Main outcome measures Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge.Results The average costs of immediate delivery (n = 352) were (sic)10 245 versus (sic)9563 for expectant monitoring (n = 351), with an average difference of (sic)682 (95% confidence interval, 95% CI -(sic)618 to (sic)2126). This 7% difference predominantly originated from the neonatal admissions, which were (sic)5672 in the immediate delivery arm and (sic)3929 in the expectant monitoring arm.Conclusion In women with mild hypertensive disorders between 34(0/7) and 37(0/7) weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications.

KW - Economic evaluation

KW - expectant monitoring

KW - hypertensive disorders

KW - immediate delivery

KW - preterm

KW - COST-EFFECTIVENESS

KW - PREECLAMPSIA

KW - INDUCTION

KW - TRIAL

KW - LABOR

KW - TERM

KW - ECLAMPSIA

U2 - 10.1111/1471-0528.13957

DO - 10.1111/1471-0528.13957

M3 - Article

C2 - 26969198

SN - 1470-0328

VL - 124

SP - 453

EP - 461

JO - Bjog-an International Journal of Obstetrics and Gynaecology

JF - Bjog-an International Journal of Obstetrics and Gynaecology

IS - 3

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van Baaren GJ, Broekhuijsen K, van Pampus MG, Ganzevoort W, Sikkema JM, Woiski MD et al. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II). Bjog-an International Journal of Obstetrics and Gynaecology. 2017 Feb;124(3):453-461. doi: 10.1111/1471-0528.13957