Economic evaluation of outpatient vs. inpatient cervical ripening using dilapan-s prior to induction of labor

To compare health system costs of outpatient to inpatient term preinduction cervical ripening with a synthetic hygroscopic cervical dilator (Dilapan-S). We performed a secondary economic evaluation of pregnant individuals enrolled in a two-center randomized clinical trial (HOMECARE) comparing outpatient to inpatient Dilapan-S for pre-induction cervical ripening at term. The primary analysis, using a superiority approach, showed that outpatient cervical ripening significantly reduced hospital stay with no increase in adverse maternal or neonatal outcomes. The primary outcome of the economic analysis was total hospital costs from Dilapan-S insertion through post-delivery discharge. Facility costs were obtained from the cost-accounting system from the University of Texas Medical Branch (UTMB) Health System or conservatively imputed for patients who delivered in a hospital outside UTMB. These costs were inflated to 2022 U.S. dollars based on the consumer price index for medical services. The cost of a Dilapan-S rod was based on its current unit list price in the U.S. ($80 per rod) multiplied by the number of rods used by each patient during cervical ripening. Differences in total hospital costs between the treatment groups were assessed using generalized linear models with a log link and gamma distribution. From 11/9/2018 through 11/4/2021, 339 participants were randomized (168 to outpatient and 171 to inpatient). All but 4 delivered at UTMB. In intent-to-treat analysis, the mean observed total cost was $7,147 in the outpatient group vs. $8,024 in the inpatient group (Table 1). Outpatient ripening decreased hospital costs by an estimated average of $879 (95% CI, $317-$1,440) per patient; cost ratio, 0.89 (0.83-0.96). Outpatient cervical ripening with synthetic osmotic cervical dilators leads to significant cost savings. Further research is needed to verify the generalizability of our findings to other centers and populations of low-risk pregnant individuals.