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Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term
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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. doi:10.1111/j.1471-0528.2011.02902.x ISSN 14700328.
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Official URL: http://dx.doi.org/10.1111/j.1471-0528.2011.02902.x
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.
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 | ||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RG Gynecology and obstetrics |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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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. | ||||
ISSN: | 14700328 | ||||
Official Date: | May 2011 | ||||
Dates: |
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Volume: | Vol.118 | ||||
Number: | No.6 | ||||
Page Range: | pp. 726-734 | ||||
DOI: | 10.1111/j.1471-0528.2011.02902.x | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access | ||||
Funder: | Medical Research Council (MRC) |
Data sourced from Thomson Reuters' Web of Knowledge
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