Cost-Effectiveness of Ritodrine and Fenoterol for Treatment of Preterm Labor in a Low–Middle-Income Country: A Case Study

ObjectivesIn countries with high income, tocolytic therapy with β-mimetic agents is a cost-effective strategy compared to placebo. In our study, the cost-effectiveness of two β-mimetic agents, ritodrine and fenoterol, used in the management of preterm labor was compared in the setting of a low–middle-income transitional country, Serbia & Montenegro.MethodsThis case study was conducted at the Gynecology-Obstetrics Clinic, Clinical Center “Kragujevac,” in Kragujevac, Serbia & Montenegro, between October 2004 and January 2006. In total, 235 pregnant patients with threatened preterm labor were enrolled, but 35 were lost to follow-up. Of the remaining 200 patients, 85 were given ritodrine, and 115 fenoterol. The perspective of Republic Institute for Health Insurance in Serbia was taken into account. Only direct costs were calculated; primary outcomes of the study were length of pregnancy (in weeks), time passed from the onset of uterine contractions to delivery (in weeks), and score on modified Flanagan's quality-of-life scale for chronic diseases, measured after discharge from hospital.ResultsProlongation of pregnancy was significantly longer in the fenoterol group (12.7 ± 8.4 weeks) than in the ritodrine group (11.6 ± 7.1 weeks). The mean duration of hospitalization was shorter in the fenoterol group (11.9 ± 8.8 days) than in the ritodrine group (14.9 ± 11.3 days). The treatment with fenoterol was less costly and more cost-effective than the treatment with ritodrine, but the difference in cost-effectiveness was not statistically significant. The cost of treatment per gained week of pregnancy prolongation was 3345.51 ± 7668.04 CSD in the fenoterol group, and 4181.96 ± 12,069.83 CSD in the ritodrine group.ConclusionsThe observed differences in treatment costs and duration of hospitalization per patient did not translate into significant differences in cost-effectiveness ratios, because of low costs of hospitalization and human labor in Serbian health system. Nevertheless, fenoterol treatment still has a tendency to be more cost-effective, and its lower acquisition cost is an advantage to this treatment option.