{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:13:45Z","timestamp":1787930025668,"version":"build-2784847793"},"reference-count":41,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003744","name":"Stiftelsen Handlanden Hjalmar Svenssons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003744","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the cost\u2010effectiveness of induction of labour (IOL) at 41\u00a0weeks of gestation compared with expectant management until 42\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cost\u2010effectiveness analysis alongside the Swedish Post\u2010term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Fourteen Swedish hospitals during 2016\u20132018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41\u00a0weeks of gestation to IOL or to expectant management and induction at 42\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Health benefits were measured in life years and quality\u2010adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost\u2010effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non\u2010parametric bootstrapping.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The cost per gained life year and per gained QALY.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6\/1373 to 0\/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was \u20ac4108 in the IOL group (<jats:italic>n<\/jats:italic>\u00a0=\u00a01373) and \u20ac4037 in the expectant management group (<jats:italic>n<\/jats:italic>\u00a0=\u00a01373), with a mean difference of \u20ac71 (95%\u00a0CI \u2212\u20ac232 to \u20ac379). The ICER for IOL compared with expectant management was \u20ac545 per life year gained and \u20ac623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Induction of labour at 41\u00a0weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost\u2010effective compared with expectant management until 42\u00a0weeks of gestation using standard threshold values for acceptable cost per life year\/QALY.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable Abstract<\/jats:title><jats:p>Induction of labour at 41\u00a0weeks of gestation is cost\u2010effective compared with expectant management until 42\u00a0weeks of gestation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16929","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T18:35:01Z","timestamp":1631903701000},"page":"2157-2165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Induction of labour at 41\u00a0weeks of gestation versus expectant management and induction of labour at 42\u00a0weeks of gestation: A\u00a0cost\u2010effectiveness analysis"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5648-3505","authenticated-orcid":false,"given":"M\u00e5rten","family":"Alkmark","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre of Perinatal Medicine &amp; Health Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla\u2010Britt","family":"Wennerholm","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre of Perinatal Medicine &amp; Health Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sissel","family":"Saltvedt","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Karolinska Institute Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Bergh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1414-7279","authenticated-orcid":false,"given":"Ylva","family":"Carlsson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre of Perinatal Medicine &amp; Health Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0000-0476","authenticated-orcid":false,"given":"Helen","family":"Elden","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"},{"name":"Institute of Health and Caring Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2691-7525","authenticated-orcid":false,"given":"Helena","family":"Fadl","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Ladfors","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre of Perinatal Medicine &amp; Health Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Sengpiel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre of Perinatal Medicine &amp; Health Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynaecology Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Wesstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Uppsala University  Uppsala Sweden"},{"name":"Center for Clinical Research Dalarna Falu Hospital  Falun Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Hagberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre of Perinatal Medicine &amp; 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