{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T06:22:05Z","timestamp":1788070925023,"version":"build-2784847793"},"reference-count":20,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T00:00:00Z","timestamp":1529625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000836","name":"University of Liverpool","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000836","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000278","name":"Department for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000278","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the effectiveness and economic impact of two methods for induction of labour in hypertensive women, in low\u2010resource settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cost\u2010consequence analysis of a previously reported multicentre, parallel, open\u2010label randomised trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting &amp; population<\/jats:title><jats:p>A total of 602 women with a live fetus, aged \u226518 years requiring delivery for pre\u2010eclampsia or hypertension, in two public hospitals in Nagpur, India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a formal economic evaluation alongside the <jats:styled-content style=\"fixed-case\">INFORM<\/jats:styled-content> clinical trial. Women were randomised to receive transcervical Foley catheterisation or oral misoprostol 25 mcg. Healthcare expenditure was calculated using a provider\u2010side microcosting approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Rates of vaginal this delivery within 24 hours of induction, healthcare expenditure per completed treatment episode.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Induction with oral misoprostol resulted in a (mean difference) $20.6USD reduction in healthcare expenditure [95% CI (\u2212) $123.59 (\u2212) $72.49], and improved achievement of vaginal delivery within 24 hours of induction, mean difference 10% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> (\u22122 to 17.9%), <jats:italic>P<\/jats:italic> = 0.016]. Oxytocin administration time was reduced by 135.3 minutes [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> (84.4\u2013186.2 minutes), <jats:italic>P<\/jats:italic> &lt; 0.01] and caesarean sections by 9.1% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> (1.1\u201317%), <jats:italic>P<\/jats:italic> = 0.025] for those receiving oral misoprostol. Following probabilistic sensitivity analysis, oral misoprostol was cost\u2010saving in 63% of 5,000 bootstrap replications and achieved superior rates of vaginal delivery, delivery within 24 hours of induction and vaginal delivery within 24 hours of induction in 98.7%, 90.7%, and 99.4% of bootstrap simulations. Based on univariate threshold analysis, the unit price of oral misoprostol 25 mcg could feasibly increase 31\u2010fold from $0.24 to $7.50 per 25 mcg tablet and remain cost\u2010saving.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to Foley catheterisation for the induction of high\u2010risk hypertensive women, oral misoprostol improves rates of vaginal delivery within 24 hours of induction and may also reduce costs. Additional research performed in other low\u2010resource settings is required to determine their relative cost\u2010effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Oral misoprostol less costly and more effective than Foley catheter for labour induction in hypertension.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15285","type":"journal-article","created":{"date-parts":[[2018,5,21]],"date-time":"2018-05-21T12:56:36Z","timestamp":1526907396000},"page":"1734-1742","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Foley catheter vs. oral misoprostol to induce labour among hypertensive women in India: a cost\u2010consequence analysis alongside a clinical trial"],"prefix":"10.1111","volume":"125","author":[{"given":"S","family":"Leigh","sequence":"first","affiliation":[{"name":"University of Liverpool Management School Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Granby","sequence":"additional","affiliation":[{"name":"University of Liverpool Management School Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Haycox","sequence":"additional","affiliation":[{"name":"University of Liverpool Management School Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Mundle","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Government Medical College Nagpur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Bracken","sequence":"additional","affiliation":[{"name":"Gynuity Health Projects New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Khedikar","sequence":"additional","affiliation":[{"name":"Daga Memorial Women's Government Hospital Nagpur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Mulik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Government Medical College Nagpur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Faragher","sequence":"additional","affiliation":[{"name":"Medical Statistics Unit Department of Clinical Sciences Liverpool School of Tropical Medicine Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Easterling","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MA","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health University of Liverpool Liverpool Women's Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z","family":"Alfirevic","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health University of Liverpool Liverpool Women's Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Winikoff","sequence":"additional","affiliation":[{"name":"Gynuity Health Projects New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AD","family":"Weeks","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health University of Liverpool Liverpool Women's Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00838-7"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08778-0"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4863.154669"},{"key":"e_1_2_6_6_1","volume-title":"WHO Recommendations for Induction of Labour","author":"WHO","year":"2011"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h217"},{"key":"e_1_2_6_8_1","first-page":"CD001338","article-title":"Oral misoprostol for induction of labour","volume":"6","author":"Alfirevic Z","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13456"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61484-0"},{"key":"e_1_2_6_11_1","first-page":"CD001233","article-title":"Mechanical methods for induction of labour","volume":"3","author":"Jozwiak M","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31367-3"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-308"},{"key":"e_1_2_6_14_1","unstructured":"The World Bank International Comparison Program Database: PPP conversion factor. 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