Comparative cost analysis of prostaglandin analogues dinoprostone and misoprostol as labor preinduction agents

Objective: To compare the relative cost efficacy of three commercially available prostaglandin analogues, misoprostol (Cytotec(R), PGE(1)), dinoprostone gel (Prepidil(R), PGE(2)), and dinoprostone pessary (Cervidil(R), PGE(2)), as labor preinduction agents.Methods: The investigation was conducted as a prospective randomized, blinded phase III clinical trial. One hundred twelve gravid females undergoing induction of labor with an unfavorable cervix (Bishop score /=6) after the initial preinduction interval in the Cytotec(R) (79.0%) and Cervidil(R) groups (60.5%) as compared to Prepidil(R) (40.0%) (P <.05). The average relative cost per patient for prostaglandin preinduction was significantly less with Cytotec(R) ($0.42) as compared to both Cervidil(R) ($168.00) and Prepidil(R) ($184.17) (P <.0001). A greater percentage of patients treated with Cytotec(R) (42.1%) achieved active labor and delivered without the use of oxytocin when compared to Cervidil(R) (15.8%) or Prepidil(R) treatment groups (2.9%) (P <.05). Additionally, time to delivery (+/-SD) was significantly shorter in the Cytotec(R) group (24.0 +/- 10.8 h) as compared to the Cervidil(R) (32.2 +/- 14.7 h) or Prepidil(R) groups (33.9 +/- 16.2 h) (P <.05). This reduction in time resulted in a significantly lower overall mean cost per patient incurred by labor induction in the Cytotec(R) group ($723.66) as compared to the Cervidil(R) ($1058.90) or Prepidil(R) treatment ($1124.84) (P <.01). No significant differences were noted with respect to rate of cesarean delivery.Conclusion: Misoprostol is more cost-effective than the comparable commercial dinoprostone prostaglandin preparations as an adjuvant to labor induction in patients with an unfavorable cervix.