Background Taylor and Armour assessed consumer preferences for two methods of induction of labour. This made it possible to conduct a cost-utility analysis; so far no study has been published including the quality of life parameter.

Purpose To investigate whether dinoprostone vaginal gel or slow release pessaries have a better incremental cost-utility ratio (ICUR) for induction of labour.

Materials and methods The authors used a simulated decision tree for cost-utility analysis, which has been described before; and took into account all end results and drug adverse reactions. For each of the options there were 108 arms in the model. The perspective was the hospital. Time horizon was less than a year so it was not necessary to discount cost or utilities. Population studied consisted of nulliparous pregnant women with Bishop score ≤4. Disutilities and the probabilities of events were extracted from reference studies. Cost (€ 2011) included the form of dinoprostone, treatment of ARD (Absolute Risk Difference, adverse drug reactions), inputs and personnel cost for administration, and DRG (diagnosis related group) for each event. The authors tested scenarios in univariate, bivariate and umbral sensitivity analysis. A cohort of 10000 for each alternative was tested in stochastic analysis.

Results In deterministic analysis, ICUR was –0.916 €/QALY. Total cost for dinoprostone gel was 3416.64€ and 8815.45 QALY; versus 2838.81€ and 9446.53 QALY for the pessary. Cost utility ratio for dinoprostone gel was 0.387 €/QALY and for the pessary 0.362 €/QALY. Univariate sensitivity analysis had the same result: the best option was dinoprostone pessaries. Umbral analysis showed cost of dinoprostone pessary over 877 €. Probabilistic sensitivity analysis, 2000 Monte Carlo simulations, showed an ICUR of -0.918 (SD: 0.004) €/QALY. For all simulations, dinoprostone pessaries dominated.

Conclusions For ripening of the cervix in nulliparous women, 10 mg of dinoprostone pessary is a better cost-utility option than two doses of 0.5 mg of dinoprostone endocervical gel,