BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed. METHODS: We performed a cost-minimization analysis alongside a multicentre randomized trial. Clinical data and data on the use of medical resources were obtained from a randomized trial comparing misoprostol and curettage, which had shown that misoprostol reduced the need for curettage in 53%. In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90%. RESULTS:Direct costs per case were significantly lower in the misoprostol group (mean 433) than in the curettage group (mean 683) (mean difference 250, 95% CI 184 to 316, P < 0.001). These significant differences existed under a wide range of alternative assumptions about unit costs. The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol. Mean indirect costs were equal for both groups (misoprostol mean 486; curettage mean 428; mean difference 60, 95% CI -61 to 179, P = 0.51). The mean total costs for a strategy starting with misoprostol was 915 versus 1107 for curettage, with a mean difference between both groups of 192 (95% CI 33 to 351, P = 0.04). An increase of the complete evacuation rates for initial misoprostol therapy to 90% in the sensitivity analysis increased the cost difference between misoprostol and curettage to 550. CONCLUSION: The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage.
RCT Entities:
BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed. METHODS: We performed a cost-minimization analysis alongside a multicentre randomized trial. Clinical data and data on the use of medical resources were obtained from a randomized trial comparing misoprostol and curettage, which had shown that misoprostol reduced the need for curettage in 53%. In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90%. RESULTS: Direct costs per case were significantly lower in the misoprostol group (mean 433) than in the curettage group (mean 683) (mean difference 250, 95% CI 184 to 316, P < 0.001). These significant differences existed under a wide range of alternative assumptions about unit costs. The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol. Mean indirect costs were equal for both groups (misoprostol mean 486; curettage mean 428; mean difference 60, 95% CI -61 to 179, P = 0.51). The mean total costs for a strategy starting with misoprostol was 915 versus 1107 for curettage, with a mean difference between both groups of 192 (95% CI 33 to 351, P = 0.04). An increase of the complete evacuation rates for initial misoprostol therapy to 90% in the sensitivity analysis increased the cost difference between misoprostol and curettage to 550. CONCLUSION: The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage.
Authors: Mary Rausch; Scott Lorch; Karine Chung; Margaret Frederick; Jun Zhang; Kurt Barnhart Journal: Fertil Steril Date: 2011-12-21 Impact factor: 7.329
Authors: Marike Lemmers; Marianne Ac Verschoor; Bobae Veronica Kim; Martha Hickey; Juan C Vazquez; Ben Willem J Mol; James P Neilson Journal: Cochrane Database Syst Rev Date: 2019-06-17
Authors: Marianne A C Verschoor; Marike Lemmers; Malu Z Wekker; Judith A F Huirne; Mariëtte Goddijn; Ben Willem J Mol; Willem M Ankum Journal: Obstet Gynecol Int Date: 2014-11-04
Authors: Ana M Cubo; Zandra M Soto; Ana Haro-Pérez; M Estrella Hernández Hernández; M José Doyague; José M Sayagués Journal: PLoS One Date: 2019-01-10 Impact factor: 3.240
Authors: Marianne A C Verschoor; Marike Lemmers; Patrick M Bossuyt; Giuseppe C M Graziosi; Petra J Hajenius; Dave J Hendriks; Marcel A H van Hooff; Hannah S van Meurs; Brent C Opmeer; Maurits W van Tulder; Liesanne Bouwma; Ruby Catshoek; Peggy Geomini; Ellen R Klinkert; Josje Langenveld; Theodoor E Nieboer; J Marinus van der Ploeg; Celine M Radder; Taeke Spinder; Lucy F van der Voet; Ben Willem J Mol; Judith A F Huirne; Willem M Ankum Journal: BMC Pregnancy Childbirth Date: 2013-05-02 Impact factor: 3.007
Authors: Jay Ghosh; Argyro Papadopoulou; Adam J Devall; Hannah C Jeffery; Leanne E Beeson; Vivian Do; Malcolm J Price; Aurelio Tobias; Özge Tunçalp; Antonella Lavelanet; Ahmet Metin Gülmezoglu; Arri Coomarasamy; Ioannis D Gallos Journal: Cochrane Database Syst Rev Date: 2021-06-01