Abstract
Objective We sought to evaluate the economic benefit of the induction of labor compared with
elective cesarean delivery in individuals with supermorbid obesity (body mass index
60 kg/m2 or greater) at term.
Study Design We developed an economic analysis model to compare induction of labor with elective
cesarean delivery in nulliparous individuals with supermorbid obesity at term. The
primary outcome was the total cost per strategy from a health system perspective with
elective cesarean delivery as a reference group. Pregnancy outcomes for the index
and subsequent pregnancies were considered. When available, probabilities of pregnancy
outcomes were extracted from our institutions. Rare pregnancy outcomes, relative risks,
and costs were derived from the literature. All costs in this analysis were inflated
to 2022 USD (U.S. dollar). To determine the robustness of the decision model, we conducted
one-way sensitivity analyses by changing point estimates of variables. We then performed
a probabilistic sensitivity analysis using Monte Carlo simulation repeating 1,000
times to test the robustness of the results in the setting of simultaneous changes
in probabilities, relative risks, and costs.
Results In the base-case analysis, assuming that 72.7% of nulliparous individuals undergoing
induction of labor would have a cesarean delivery, induction of labor would cost $41,084
compared with $40,742 for elective cesarean delivery, resulting in a higher cost of
$342 per nulliparous individuals with supermorbid obesity. In a sensitivity analysis,
we found that induction of labor compared with elective cesarean is less economical
if the probability of cesarean delivery after induction of labor exceeds 71%. Monte
Carlo simulation suggests that elective cesarean delivery was the preferred cost-beneficial
strategy with a frequency of 53.5%.
Conclusion: Among our patient population, induction of labor was less economical compared with
elective cesarean delivery at term for nulliparous individuals with supermorbid obesity.
Key Points
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The prevalence of obesity in the United States continues to rise.
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Morbid obesity compared with normal weight is associated with increased risks of adverse
pregnancy outcomes.
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Induction of labor was less economical compared with elective cesarean delivery at
term for nulliparous individuals.
Keywords
obesity - induction of labor - cesarean delivery - economic analysis
