A Change in Cervical Ripening Agents Leads to a Significant Reduction in Expenditure [33C

Abstract

INTRODUCTION: Each year approximately 3,000 deliveries occur at NBIMC labor and delivery. Of these deliveries, approximately 700 begin as inductions of labor. In June of 2016 the primary induction medication was switched from dinoprostone $428.53 per insert to misoprostol $1.85 per induction. The purpose of this project was to determine the outcomes in regard to inductions leading to vaginal birth versus cesarean delivery and estimated expenditures per cervical ripening medication. METHODS: IRB approval was obtained and then a retrospective chart review of all deliveries at NBIMC from January 1st 2016 until December 31st 2016 was performed with an analysis of successful vaginal deliveries for each induction medication versus failed inductions resulting in cesarean deliveries and the indications for cesarean delivery. The data was extrapolated to estimate the approximated savings from changing induction medication and a comparison for reasons for induction failure. RESULTS: There was a no significant difference between the two groups regarding delivery method (misoprostol cesarean delivery 29.72% versus dinoprostone cesarean delivery 35.51%, p-value 0.194). The dinoprostone 10mg vaginal insert was used a single time per induction of labor and cost approximately $428.53. Thus, the 245 inductions had an estimated cost of $104,989.85. In contrast, the misoprostol cervical ripening protocol consisted of misoprostol 25mcg PV for 3 doses followed by misoprostol 50mcg PO for 3 doses. This totaled 225mcg of misoprostol at a cost of $1.85. The total cervical ripening cost of 286 inductions is therefore estimated at $530.35. This is a stark contrast to the single dinoprostone insert costing $428.53. Extrapolating the data to approximately 700 inductions per year: the total cost for dinoprostone would be $299,971 versus misoprostol at $1,295, and the savings from switching to misoprostol would be $298,676. CONCLUSION: Changing the induction cervical ripening medication from dinoprostone to misoprostol has saved the department and NBIMC approximately $298,676 per year with a statistically significant similar successful induction rate. Our study has led to changing our institutions cervical ripening agent to a more cost effective agent with a similar delivery outcome.