Misoprostol Vaginal Insert in Labor Induction: A Cost–Consequences Model for 5 European Countries—An Economic Evaluation Supported with Literature Review and Retrospective Data Collection

Adam Bierut, Jadwiga Dowgiałło-Smolarczyk, Izabela Pieniążek, Jarosław Stelmachowski, Kinga Pacocha, Maciej Sobkowski, Oleg R. Baev, Jacek Walczak

The present study aimed to assess the costs and consequences of using an innovative medical technology, misoprostol vaginal insert (MVI), for the induction of labor (IOL), in place of alternative technologies used as a standard of care. This was a retrospective study on cost and resource utilization connected with economic model development. Target population were women with an unfavorable cervix, from 36 weeks of gestation, for whom IOL is clinically indicated. Data on costs and resources was gathered via a dedicated questionnaire, delivered to clinical experts in five EU countries. The five countries participating in the project and providing completed questionnaires were Austria, Poland, Romania, Russia and Slovakia. A targeted literature review in Medline and Cochrane was conducted to identify randomized clinical trials meeting inclusion criteria and to obtain relative effectiveness data on MVI and the alternative technologies. A hospital perspective was considered as most relevant for the study. The economic model was developed to connect data on clinical effectiveness and safety from randomized clinical trials with real life data from local clinical practice. The use of MVI in most scenarios was related to a reduced consumption of hospital staff time and reduced length of patients' stay in hospital wards, leading to lower total costs with MVI when compared to local comparators. IOL with the use of MVI generated savings from a hospital perspective in most countries and scenarios, in comparison to alternative technologies. Sponsorship, article processing charges, and the open access charge for this study were funded by Ferring Pharmaceuticals Poland.