OBJECTIVE: To determine the cost-effectiveness of medical and surgical management of early pregnancy loss. DESIGN: Analyses of cost, effectiveness, and incremental cost-effectiveness ratios and utilities of a multicenter trial with 652 women with first-trimester pregnancy failure randomized to medical or surgical management. SETTING: Analysis of data from a multicenter trial. PATIENT(S): Secondary analysis of a multicenter trial. INTERVENTION(S): Cost-effectiveness analysis. MAIN OUTCOME MEASURE(S): Cost and effectiveness of competing treatment strategies. RESULT(S): Cost analysis of treatment demonstrates an increased cost of US$336 for 13% increased efficacy of surgical management. This analysis was sensitive to the probability of an extra office visit, the cost of the visit, and the probability of success. When the surgical arm is divided into outpatient manual vacuum aspiration (MVA) versus inpatient electric vacuum aspiration (EVA), there is an increased cost of $745 for EVA but a decreased cost of $202 for MVA compared with medical management. In general, MVA was found to be more cost-effective than medical management. For treatment of incomplete or inevitable abortion, medical management was found to be less costly and more efficacious. Utilities studies demonstrated that a patient would need to prefer surgery 14% less than medication for its treatment efficacy to be outweighed by the desire to avoid surgery. CONCLUSION(S): Surgical or medical management of early pregnancy failure can be cost effective, depending on the circumstances. Surgery is cost effective and more efficacious when performed in an outpatient setting. For incomplete or inevitable abortion, medical management is cost effective and more efficacious.
RCT Entities:
OBJECTIVE: To determine the cost-effectiveness of medical and surgical management of early pregnancy loss. DESIGN: Analyses of cost, effectiveness, and incremental cost-effectiveness ratios and utilities of a multicenter trial with 652 women with first-trimester pregnancy failure randomized to medical or surgical management. SETTING: Analysis of data from a multicenter trial. PATIENT(S): Secondary analysis of a multicenter trial. INTERVENTION(S): Cost-effectiveness analysis. MAIN OUTCOME MEASURE(S): Cost and effectiveness of competing treatment strategies. RESULT(S): Cost analysis of treatment demonstrates an increased cost of US$336 for 13% increased efficacy of surgical management. This analysis was sensitive to the probability of an extra office visit, the cost of the visit, and the probability of success. When the surgical arm is divided into outpatient manual vacuum aspiration (MVA) versus inpatient electric vacuum aspiration (EVA), there is an increased cost of $745 for EVA but a decreased cost of $202 for MVA compared with medical management. In general, MVA was found to be more cost-effective than medical management. For treatment of incomplete or inevitable abortion, medical management was found to be less costly and more efficacious. Utilities studies demonstrated that a patient would need to prefer surgery 14% less than medication for its treatment efficacy to be outweighed by the desire to avoid surgery. CONCLUSION(S): Surgical or medical management of early pregnancy failure can be cost effective, depending on the circumstances. Surgery is cost effective and more efficacious when performed in an outpatient setting. For incomplete or inevitable abortion, medical management is cost effective and more efficacious.
Authors: G C M Graziosi; J W van der Steeg; P H W Reuwer; A P Drogtrop; H W Bruinse; B W J Mol Journal: Hum Reprod Date: 2004-12-23 Impact factor: 6.918
Authors: Jun Zhang; Jerry M Gilles; Kurt Barnhart; Mitchell D Creinin; Carolyn Westhoff; Margaret M Frederick Journal: N Engl J Med Date: 2005-08-25 Impact factor: 91.245
Authors: A J Wilcox; C R Weinberg; J F O'Connor; D D Baird; J P Schlatterer; R E Canfield; E G Armstrong; B C Nisula Journal: N Engl J Med Date: 1988-07-28 Impact factor: 91.245
Authors: Lauren B Messinger; Connie E Alford; John M Csokmay; Melinda B Henne; Sunni L Mumford; James H Segars; Alicia Y Armstrong Journal: Fertil Steril Date: 2015-05-23 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; 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
Authors: Susanne Sjöström; Helena Kopp Kallner; Emilia Simeonova; Andreas Madestam; Kristina Gemzell-Danielsson Journal: PLoS One Date: 2016-06-30 Impact factor: 3.240