title: Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of prostaglandin E2 (dinoprostone) vaginal gel for the induction of labour at term from the perspective of the UK's National Health Service.
  
  
  METHODS
  Economic evaluation conducted as part of a randomised controlled trial.
  
  
  METHODS
  Maternity department at a major teaching hospital in London, UK.
  
  
  METHODS
  A cohort of 165 pregnant women presenting as cephalic between 36(+⁶) and 41(+⁶) weeks of gestation, for whom induction of labour was deemed necessary.
  
  
  METHODS
  Either 3-mg Prostin E2 vaginal tablets or 1- or 2-mg Prostin E2 vaginal gel were administered at 6-hourly intervals.
  
  
  METHODS
  Incremental cost per hour prevented between induction and delivery. The nonparametric bootstrap method was used to construct cost-effectiveness acceptability curves and estimate net benefits at alternative cost-effectiveness thresholds.
  
  
  RESULTS
  Women receiving the gel accrued nonsignificantly higher costs (incremental cost £630; bootstrap 95% CI -£353, £2320; P = 0.43), and experienced a significantly reduced interval between induction and delivery (median of 1400 versus 1780 minutes; mean of 1711 versus 2765 minutes; P = 0.03). The incremental cost per hour prevented from induction of labour to delivery was estimated at £36. At a cost-effectiveness threshold of £100 per hour of care prevented, the probability that the gel is cost-effective was estimated at 0.83, and the mean net benefit to the health services was estimated at £1121 (bootstrap 95% CI -£1133, £3379). The results were sensitive to the inclusion of neonatal costs in the analysis and the value of the cost-effectiveness threshold. Notably, excluding neonatal costs increased the probability that the gel is cost-effective at a cost-effectiveness threshold of £100 per hour of care prevented to 0.99.
  
  
  CONCLUSIONS
  This study suggests that prostaglandin E2 gel is probably more cost-effective than prostaglandin E2 tablets for the induction of labour at term. Given that the results are applicable to the general obstetric population requiring induction of labour at term, decision-makers should consider the likely economic impacts of their implementation.
authors.affiliation: Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. s.petrou@warwick.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Petrou
authors.forename: Se
authors.initials: S
authors.lastname: Taher
authors.forename: G
authors.initials: G
authors.lastname: Abangma
authors.forename: O
authors.initials: O
authors.lastname: Eddama
authors.forename: P
authors.initials: P
authors.lastname: Bennett
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D015232:Dinoprostone; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007751:Labor, Induced / Q000191:economics* / Q000379:methods; D007902:Length of Stay; D007744:Obstetric Labor Complications / Q000209:etiology; D010120:Oxytocics; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics*; D013607:Tablets / Q000191:economics; D047929:Term Birth; D014622:Vaginal Creams, Foams, and Jellies / Q000191:economics
chemical_list: D010120:Oxytocics; D013607:Tablets; D014622:Vaginal Creams, Foams, and Jellies; D015232:Dinoprostone