OBJECTIVES: We aimed to determine the cost-effectiveness of atosiban compared to betamimetics in the treatment of preterm labour in Austria. METHODS: A systematic literature review identified RCTs comparing atosiban to betamimetics in the first 48 hours of hospitalisation. In Austria hexoprenaline is the most common betamimetic indicated for preterm labour, and previous research had demonstrated comparable safety profiles within this group. Cost-minimisation analysis was conducted using Excel model of the combined ITT population. Drug dosing was based on clinical trial protocols and Austrian treatment guidelines. Costs of drugs were obtained for 2009. The Hospital Financing System (LKF) score was calculated using the 2009 Kdok software. Analyses were conducted from the payer (KRAZAF) and hospital (KAV) perspectives. RESULTS: Six RCTs were identified: three double-blinded, one single-blinded, and two open label studies. Meta-analysis of the double blinded studies showed, that atosiban and betamimetics had similar efficacy (RR=0.99, 95%CI:0.94-1.04, p=0.772) in preventing preterm labour for 48 hours. Atosiban was associated with a significantly lower frequency of adverse events for tachycardia, palpitation, vomiting, headache, hyperglycaemia, tremor, dyspnoea, chest pain, hypocalemia and foetal tachycardia (p<0.05). From the public payer perspective, the cost saving from choosing atosiban over hexoprenaline was €323 per patient. From the hospital perspective, savings ranged from €807 for 18 hours of tocolysis to €721 for 48 hours. The results were consistent when the double-blinded clinical trials were analysed separately or combined with the single-blinded and open label trials, and were robust in the probabilistic sensitivity analysis, where cost savings were achieved in 83-100% of bootstrapped cases. The switch from hexoprenaline to atosiban would lead to savings ranging from 41% to 83%. CONCLUSIONS: Atosiban is cost saving versus betamimetics in the treatment of preterm labour in Austria from both the payer and hospital perspectives. Cost savings result from the superior safety profile of atosiban.