Am J Perinatol 2020; 37(03): 245-251
DOI: 10.1055/s-0039-1694791
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outpatient Cervical Ripening: A Cost-Minimization and Threshold Analysis

1  Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah
,
Ashley E. Benson
1  Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah
,
Emily Hart Hayes
3  University of Utah College of Nursing, Salt Lake City, Utah
,
Akila Subramaniam
4  Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
5  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Erin A. S. Clark
1  Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah
,
Brett D. Einerson
1  Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah
› Author Affiliations
Further Information

Publication History

29 April 2019

04 July 2019

Publication Date:
20 August 2019 (online)

Abstract

Objective To evaluate cost of outpatient (OP) versus inpatient (IP) ripening with transcervical balloons, and determine circumstances in which each strategy would be cost saving.

Study Design We created a decision model comparing OP and IP balloon ripening in term (≥37 weeks) singleton pregnancies with unfavorable cervix. We performed a cost-minimization analysis and threshold analyses comparing two OP ripening strategies (broad and limited use) to IP ripening from a health system perspective. Base case estimates of probability, utilization, and cost were derived from the literature. The primary outcome was incremental cost of OP versus IP ripening from a hospital perspective. One- and two-way sensitivity analyses explored uncertainty in the model.

Results Both OP ripening strategies were cost saving compared with IP ripening: incremental cost −$228.40/patient with broad use and −$73.48/patient with limited use. OP ripening was no longer cost saving if hours saved on labor and delivery (L&D) were <3.5, insertion visit cost >$714, or facility cost/hour on L&D <$61. Two-way sensitivity analyses showed that OP ripening was cost saving under the most plausible clinical circumstances.

Conclusion In patients with unfavorable cervix, OP transcervical balloon ripening was cost saving under a wide range of circumstances, particularly if OP ripening can shorten time spent on L&D by 3.5 hours.

Note

These data were presented in a poster form at the Society for Maternal-Fetal Medicine Annual Pregnancy Meeting 2019 in Las Vegas, NV, on February 15, 2019.