A cost-minimization analysis of intracervical prostaglandin E(2) for cervical ripening in an outpatient versus inpatient setting

This investigation was undertaken to compare the cost impact of prostaglandin E(2) gel delivered intracervically in an outpatient versus an inpatient setting. Eligible pregnant women with a singleton gestation that was beyond 37 weeks gestational age and who had an unfavorable cervix (Bishop score less than or equal to 4) received a single dose of 0.5 mg of prostaglandin E(2) intracervically as an outpatient or one or more doses as an inpatient the day before a scheduled induction of labor. After gel placement, the outpatient group was monitored for 2 hours with electronic fetal monitoring before being sent home, while the inpatient group was monitored for 2 hours in a labor and delivery unit and then sent to the maternity unit overnight. The outpatient (n = 30) and inpatient (n = 36) groups were not different in terms of maternal age, race, parity, gestational age, maternal weight, predose Bishop score, or indication for delivery. Patients in the outpatient group incurred significantly less costs ($3835.00 +/- 2172.00 vs $5049.00 +/- 2060.00) and time (74.4 +/- 33.1 hours vs 100.3 +/- 41.6 hours) in the hospital than did patients in the inpatient group. Multiparous patients in the outpatient group, compared with those in the inpatient group, spent fewer total hours in the hospital (56.6 +/- 19.3 vs 90.3 +/- 41.0 hours) and had a lower hospital cost ($2891.00 +/- 1236.00 vs $4704.00 +/- 2100.00). The only difference between the nulliparous groups favored outpatient therapy because of less intrapartum expenses ($730.00 +/- 405.00 vs $1036.00 +/- 487.00). There were no differences between the inpatient and outpatient groups for the frequencies of failed inductions, abnormal fetal heart rate patterns, and cesarean sections. No adverse maternal or neonatal effects with therapy were encountered in either setting. Substantial cost savings were found with prostaglandin E(2) therapy in an outpatient rather than an inpatient setting for patients who required an induction of labor and were candidates for outpatient cervical ripening.