OBJECTIVES Our aim was to assess the costs and consequences of labour induction using misoprostol vaginal insert (MVI) compared with currently used technologies using a specifically developed user-friendly decision model developed for Austria, Poland, Romania, Russia and Slovakia. METHODS The model was developed in Microsoft Office Excel and compares clinical and safety aspects like time to vaginal delivery, time to active labour, occurrence of cesarean delivery and adverse events of MVI with selected comparators. Efficacy and safety data were retrieved from targeted literature review, conducted in the main medical databases. Country-specific information about costs and resource use was incorporated into the model. Local data were collected for each country via a specifically developed questionnaire. The model considered the hospital and public payer perspectives. The model generated results as an incremental difference between the total costs related to labour induction with MVI or a comparator. The threshold price of MVI was also calculated. RESULTS Local Key Opinion Leaders recommended the following comparators: dinoprostone vaginal insert (DVI; Austria), dinoprostone vaginal tablets (Dtab; Austria, Slovakia), dinoprostone cervical gel (Dgel; Poland, Russia, Slovakia) and oxytocin (Austria, Poland, Romania, Russia). The hospital perspective was chosen as default (additionally the public payer perspective was adopted for 2 countries). The use of MVI in most scenarios is related to a reduction in time consumption of hospital staff and in the length of patients’ stay in hospital wards. MVI was less costly or marginally more expensive in 80% of cases. CONCLUSIONS Induction of labour with the use of MVI using a hospital perspective, brought savings in most countries and scenarios in comparison to other prostaglandins (DVI, Dtab, Dgel).