System-Wide Effort to Reduce Cost of Cervical Ripening [29J]

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To evaluate change in usage, acquisition costs, and cesarean section (CS) rates after a system-wide effort was made to reduce the use of dinoprostone controlled-release 10 mg-PGE2 vaginal insert (PGE2) and to increase the use of vaginal misoprostol (PGE1) for cervical ripening.


A retrospective analysis was performed on available SSM Health—St. Louis data in patients undergoing cervical ripening from Nov. 2012 through May 2015. The data were examined for: percentage of patients using PGE2 and PGE1, acquisition costs for PGE2, and CS rates for two time periods. A two sample test of proportions was performed to analyze the reduction in use of PGE2.


During the 31-month period there was a system-wide reduction in usage of 10 mg-PGE2 inserts from 38.4% averaged over the first 12 months (Nov 2012–Oct 2013) to 14.7% over the last 12 months (June 2014–May 2015), for a 61.7% decrease (P<.01). Use of PGE1 increased from 61.9% to 85.6%. Accordingly, acquisition costs of PGE2 decreased, for a 47.4% reduction (P<.01). A subset of patients who received cervical ripening were analyzed for delivery outcomes, showing a CS rate of 26.8% compared to 24.2%, respectively.


Decreasing the use of controlled-release PGE2 for cervical ripening in favor of other agents like vaginal PGE1 can reduce costs without adversely affecting CS rates. With an increased focus on cost-effective, outcome driven health care delivery, every effort should be made to utilize less expensive alternative medications that seem to be at least equally as effective in regards to CS rates.

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