Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term
Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term
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DOI：
10.1111/j.1471-0528.2011.02902.x
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发表时间：
2011-05-01
影响因子：
5.8
通讯作者：
Bennett, P.
中科院分区：
文献类型：
--
作者：
Petrou, S.;Taher, S. E.;Bennett, P.
目的 从英国国民医疗服务体系的角度评估前列腺素 E2（地诺前列酮）阴道凝胶用于足月引产的成本效益。设计作为随机对照试验的一部分进行经济评估。产科设置在英国伦敦的一家大型教学医院。人群 165 名在妊娠 36(+6) 至 41(+6) 周期间表现为头侧的孕妇进行引产的队列方法 每隔 6 小时服用 3 毫克 Prostin E2 阴道片或 1 或 2 毫克 Prostin E2 阴道凝胶。 主要结果指标 预防引产和分娩之间每小时的增量成本。非参数自助法用于构建成本效益可接受性曲线，并估计替代成本效益阈值下的净效益。 结果 接受凝胶的妇女产生了非显着较高的成本（增量成本 630；磅自助法 95% CI -353 磅，2320；磅 P = 0.43），并且引产和分娩之间的时间间隔显着缩短（中位数为 1400 与1780 分钟；1711 分钟与 2765 分钟的平均值；P = 0.03）。从引产到分娩的每小时增量成本估计为 36 磅。在每小时预防护理 100 磅的成本效益阈值下，凝胶具有成本效益的概率估计为 0.83，卫生服务的平均净效益估计为 1121 磅（引导 95% CI -1133 磅，3379）磅。结果对分析中纳入的新生儿成本以及成本效益阈值敏感。值得注意的是，排除新生儿成本，凝胶在每小时护理 100 磅的成本效益阈值下具有成本效益的可能性增加到 0.99。 结论 这项研究表明，对于足月引产，前列腺素 E2 凝胶可能比前列腺素 E2 片剂更具成本效益。鉴于结果适用于需要足月引产的一般产科人群，决策者应考虑其实施可能产生的经济影响。
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; pound bootstrap 95% CI -353 pound, 2320; pound 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 pound. At a cost-effectiveness threshold of 100 pound 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 pound (bootstrap 95% CI -1133 pound, 3379) pound. 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 pound 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.