Induction of labor using prostaglandin vaginal gel: cost analysis comparing early amniotomy with repeat prostaglandin gel

Beckmann, Michael, Merollini, Katharina, Kumar, Sailesh and Flenady, Vicki (2016) Induction of labor using prostaglandin vaginal gel: cost analysis comparing early amniotomy with repeat prostaglandin gel. European Journal of Obstetrics Gynecology and Reproductive Biology, 199 96-101. doi:10.1016/j.ejogrb.2016.01.041


Author Beckmann, Michael
Merollini, Katharina
Kumar, Sailesh
Flenady, Vicki
Title Induction of labor using prostaglandin vaginal gel: cost analysis comparing early amniotomy with repeat prostaglandin gel
Journal name European Journal of Obstetrics Gynecology and Reproductive Biology   Check publisher's open access policy
ISSN 1872-7654
0301-2115
Publication date 2016-04-01
Sub-type Article (original research)
DOI 10.1016/j.ejogrb.2016.01.041
Open Access Status Not Open Access
Volume 199
Start page 96
End page 101
Total pages 6
Place of publication Shannon, Clare Ireland
Publisher Elsevier Ireland
Collection year 2017
Language eng
Subject 2729 Obstetrics and Gynaecology
2743 Reproductive Medicine
Formatted abstract
Background: In a randomized controlled trial of two policies for induction of labor (IOL) using Prostaglandin E2 (PGE2) vaginal gel, women who had an earlier amniotomy experienced a shorter IOL-to-birth time.

Objective: To report the cost analysis of this trial and determine if there are differences in healthcare costs when an early amniotomy is performed as opposed to giving more PGE2 vaginal gel, for women undergoing IOL at term.

Study design: Following an evening dose of PGE2 vaginal gel, 245 women with live singleton pregnancies, ≥37+0 weeks, were randomized into an amniotomy or repeat-PGE2 group. Healthcare costs were a secondary outcome measure, sourced from hospital finance systems and included staff costs, equipment and consumables, pharmacy, pathology, hotel services and business overheads. A decision analytic model, specifically a Markov chain, was developed to further investigate costs, and a Monte Carlo simulation was performed to confirm the robustness of these findings. Mean and median costs and cost differences between the two groups are reported, from the hospital perspective.

Results: The healthcare costs associated with IOL were available for all 245 trial participants. A 1000-patient cohort simulation demonstrated that performing an early amniotomy was associated with a cost-saving of $AUD289 ($AUD7094 vs $AUD7338) per woman induced, compared with administering more PGE2. Propagating the uncertainty through the model 10,000 times, early amniotomy was associated with a median cost savings of $AUD487 (IQR -$AUD573, +$AUD1498).

Conclusions: After an initial dose of PGE2 vaginal gel, a policy of administering more PGE2 when the Modified Bishop's score is <7 was associated with increased healthcare costs compared with a policy of performing an amniotomy, if technically possible. Length of stay was the main driver of healthcare costs.
Keyword Cervical ripening
Cost analysis
Dinoprostone
Health care costs
Labor, induced
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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