Synthetic osmotic dilators (Dilapan-S) or dinoprostone vaginal inserts (Propess) for inpatient induction of labour: A UK cost-consequence model

Walker, Kate F.; Zaher, Summia; Torrejon Torres, Rafael; Saunders, Sita J.; Saunders, Rhodri; Gupta, Janesh K.

Abstract

To estimate the costs of synthetic osmotic dilators (Dilapan-S) compared to dinoprostone vaginal inserts (Propess) for inpatient induction of labour (IOL). A population-level, Markov model-based cost-consequence analysis was developed to compare the impact of using Dilapan-S versus Propess. The time horizon was modelled from admission to birth. The target population was women requiring inpatient IOL from 37 weeks with an unfavourable cervix in the UK. Mean population characteristics reflected those of the SOLVE (NCT03001661) trial. No patient data were included in this analysis. The care pathways and staff workload were modelled using data from the SOLVE trial and clinical experience. Cost and clinical inputs were sourced from the SOLVE trial and peer-reviewed literature. Costs were inflated to 2020 British pounds (GBP, £). Outcomes were reported as an average per woman for total costs and required staff time (minutes) from admission for IOL until birth. The model robustness was assessed using a probabilistic, multivariate sensitivity analysis of 2,000 simulations with results presented as the median (interquartile range, IQR). Dilapan-S was cost neutral compared to Propess. Midwife and obstetrician times were decreased by 146 min (-11%) and 11 min (-54%), respectively. Sensitivity analysis showed that in 78% of simulations, use of Dilapan-S reduced midwife time with a median of -160 min (IQR -277 to -24 min). Costs were reduced in 54% of simulations (median -£33, IQR -£319 to £282). The model indicates that adoption of Dilapan-S is likely to be cost-neutral and reduce staff workload in comparison to Propess. Results require support from real-world data and further exploration of Dilapan-S is to be encouraged. [Abstract copyright: Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.]

• Journal Article Type: Article
• Acceptance Date: Aug 25, 2022
• Online Publication Date: Sep 16, 2022
• Publication Date: Nov 30, 2022
• Deposit Date: May 11, 2023
• Publicly Available Date: May 11, 2023
• Journal: European Journal of Obstetrics and Gynecology and Reproductive Biology
• Print ISSN: 0301-2115
• Electronic ISSN: 1872-7654
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 278
• Pages: 72-76
• DOI: https://doi.org/10.1016/j.ejogrb.2022.08.018
• Keywords: Prostaglandins, Cost of care, Labour induction, Synthetic osmotic dilator, Cervical ripening, Health economics
• Public URL: https://nottingham-repository.worktribe.com/output/12316879
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0301211522004833