OBJECTIVES: To compare the costs of induction of labor with the costs of an expectant management strategy in women with pregnancy-induced hypertension (PIH) or preeclampsia (PE) at term.  METHODS: The Hypertension and Preeclampsia Intervention Trial At Term (HYPITAT) was a multicentre randomized controlled clinical trial conducted in the Netherlands between October 2005 and April 2008. Women diagnosed with PIH or PE at ≥ 36 weeks of gestation were randomly allocated to either induction of labor or expectant management. The study showed that induction of labor reduced both maternal complications as well as the caesarean section rate as compared to expectant management.The economic analysis was performed from a societal perspective. Resource utilization was documented by specific items in the Case Report Forms (CRF) and additional questionnaires. For most medical unit costs, we used estimates provided by the financial and economic departments of two participating hospitals (one academic and one general hospital). For non-medical costs and primary care costs Dutch standardized prices were used. Sensitivity analyses were performed to explore the impact of different assumptions and cost estimates on the results of the costs analysis.   RESULTS: Data of 756 women were analyzed. Mean costs per patient were €5400 for induction and € 6025 for expectant management (difference €625). This 10% difference predominantly originated in the ante partum period: per patient €977 for induction versus €1929 for expectant management. Comparable costs were found for delivery (€ 761 versus € 790 per patient). No substantial differences were found in the post partum period.    CONCLUSIONS: In women with PIH or PE at term, costs associated with induction of labor are considerably lower as compared to expectant management. This cost reduction is mainly due to differences in resource utilization in the ante partum period.