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

doi: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)

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

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Abstract

To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. 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. A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. 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. The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI -€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. 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. Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery

Original language	English
Pages (from-to)	453-461
Journal	BJOG
Volume	124
Issue number	3
Early online date	2016
DOIs	https://doi.org/10.1111/1471-0528.13957
Publication status	Published - 2017

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https://doi.org/10.1111/1471-0528.13957

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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., ... Langenveld, J. (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, 124(3), 453-461. https://doi.org/10.1111/1471-0528.13957

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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 = "To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. 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. A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. 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. The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI -€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. 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. Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery",

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",

year = "2017",

doi = "https://doi.org/10.1111/1471-0528.13957",

language = "English",

volume = "124",

pages = "453--461",

journal = "BJOG",

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 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, vol. 124, no. 3, pp. 453-461. https://doi.org/10.1111/1471-0528.13957

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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.

PY - 2017

Y1 - 2017

N2 - To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. 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. A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. 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. The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI -€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. 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. Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery

AB - To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. 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. A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. 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. The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI -€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. 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. Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery

U2 - https://doi.org/10.1111/1471-0528.13957

DO - https://doi.org/10.1111/1471-0528.13957

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SN - 1470-0328

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