Objective: The purpose of this study was to determine the optimal tocolytic agent, based on a cost decision analysis.
Study design: A PubMed search of commonly used tocolytics was performed to determine the probability of adverse events. Cost for an agent was determined by acquisition cost and the probability and cost of adverse events. A decision tree was constructed to determine which tocolytic had the lowest total costs, with subsequent sensitivity analysis.
Results: A total of 19 clinical trials combined for a cohort of 1073 patients (indomethacin, 176 patients; magnesium sulfate, 451 patients; nifedipine, 176 patients; and terbutaline, 270 patients). The probability of adverse events was 57.9% for terbutaline, 22.0% for magnesium sulfate, 27.2% for nifedipine, and 11.4% for indomethacin. Nifedipine ($16.75) and indomethacin ($15.40) were the least expensive treatment options, compared with magnesium sulfate ($197.90) and terbutaline ($399.02) because of the cost of monitoring and treating adverse events.
Conclusion: If one elects a tocolytic, both nifedipine and indomethacin should be the agents of choice, based on a cost decision analysis.