Cost‐effectiveness analysis of prostaglandin E2 gel for the induction of labour at term

Please cite this paper as: Petrou S, Taher S, Abangma G, Eddama O, Bennett P. Cost‐effectiveness analysis of prostaglandin E2 gel for the induction of labour at term. BJOG 2011;118:726–734. 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. Design  Economic evaluation conducted as part of a randomised controlled trial. Setting  Maternity department at a major teaching hospital in London, UK. Population  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. Main outcome measures  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.