Objective: Treatment of preterm labour constitutes considerable inpatient cost, and use of tocolytics is central in delaying birth to allow neonatal lungs to mature. The study aimed to compare cost implications of adverse events following tocolysis with atosiban and beta-mimetics. Methods: Major literature databases were systematically searched to identify randomised clinical trials comparing atosiban with beta-mimetics during the initial 48h of hospitalisation. Adverse events data from three double blind trials were included in a meta-analysis. Clinical resource use was determined based on routine practice in a regional German hospital. Cost of drug treatment was calculated based on trial protocols and German hospital drug purchase costs; analysis was performed for fenoterol, the only beta-mimetic licensed in Germany for tocolysis. Costs per case were calculated with G-DRG Grouper. Costs were expressed in €2007. Results: Use of atosiban was associated with significantly lower frequency of adverse events compared to beta-mimetics. From the payer's perspective, cost-saving from using atosiban versus fenoterol was €423 per patient starting treatment. From the hospital's perspective, savings from using atosiban versus continuous fenoterol ranged from €259 for 18 hours of tocolysis to €105 for 48 hours; the respective values for bolus fenoterol were €244 and €55. From the combined perspective, using atosiban versus continuous fenoterol saved from €226 for 18 hours of tocolysis to €71 for 48 hours; versus bolus fenoterol the results were €211 and €21, respectively. In the probabilistic sensitivity analysis atosiban was cost-saving versus both continuous and bolus fenoterol in 100% of iterations at 18 hours and in at least 87% of iterations at 48 hours. Conclusion: Atosiban was cost-saving versus beta-mimetics in the treatment of preterm labour in Germany from the payer's, hospital's and combined perspectives. The results were robust in the probabilistic sensitivity analysis.