Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term
Petrou, Stavros, Taher, S. E., Abangma, Giselle, Eddama, O. and Bennett, Phillip R.. (2011) Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term. BJOG: An International Journal of Obstetrics & Gynaecology, Vol.118 (No.6). pp. 726-734. ISSN 14700328Full text not available from this repository.
Official URL: http://dx.doi.org/10.1111/j.1471-0528.2011.02902.x
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.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RA Public aspects of medicine
R Medicine > RG Gynecology and obstetrics
|Divisions:||Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
|Library of Congress Subject Headings (LCSH):||Medical economics, Medical care, Cost of, Labor, Induced (Obstetrics), Prostaglandins E -- Research, Clinical trials|
|Journal or Publication Title:||BJOG: An International Journal of Obstetrics & Gynaecology|
|Publisher:||Wiley-Blackwell Publishing Ltd.|
|Official Date:||May 2011|
|Page Range:||pp. 726-734|
|Access rights to Published version:||Restricted or Subscription Access|
|Funder:||Medical Research Council (MRC)|
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