Cost-Effectiveness Analysis of Mechanical and Pharmaceutical Methods of Labor Induction in Pregnant Women in Iran.

Background: Prescribing medication, employing mechanical interventions, and utilizing complementary methods are common practices for inducing labor. This study aimed to evaluate the cost-effectiveness of various labor induction methods in Iran.

Methods: A comprehensive economic evaluation was conducted through cost-effectiveness analysis from the perspective of Iran's health system. This study assessed misoprostol, oxytocin, and the use of a catheter. A decision analysis model, specifically a decision tree, was developed to facilitate this cost-effectiveness analysis. Data on cost variables were sourced from patient bills, medical records, treatment guidelines, government tariffs, and official drug prices. The primary outcome measured was quality-adjusted life years (QALYs), analyzed via the incremental cost-effectiveness ratio (ICER). Both deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty in model parameters. Tree Age 2020 software was utilized for analyzing various stages.

Results: The catheter intervention was less costly 75,565,520 Rials(1,171 US$), with greater effectiveness, (0.628) compared with the other methods. The calculations of the net monetary benefit (NMB) for the strategies demonstrated that the catheter intervention, with a value of 364,374,089 Rials (5,646 US$), represented the highest monetary value in this comparison. Conversely, probabilistic sensitivity analysis, employing Monte Carlo simulation, demonstrated that in 1000 iterations, the catheter treatment method emerged as the optimal intervention with an 87% probability, while misoprostol was optimal with a 5% probability.

Conclusion: Our economic evaluation revealed that the mechanical catheter method emerged as the dominant and cost-effective strategy compared with other methods.