Marike Lemmers1,2, Marianne A C Verschoor1, Patrick M Bossuyt3, Judith A F Huirne2, Teake Spinder4, Theodoor E Nieboer5, Marlies Y Bongers6, Ineke A H Janssen7, Marcel H A Van Hooff8, Ben W J Mol9, Willem M Ankum1, Judith E Bosmans10. 1. Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands. 2. Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, the Netherlands. 3. Clinical Research Unit, University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands. 4. Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, the Netherlands. 5. Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. 6. Department of Obstetrics and Gynecology, Grow-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands. 7. Department of Obstetrics and Gynecology, Groene Hart Hospital, Gouda, the Netherlands. 8. Department of Obstetrics and Gynecology, Sint Franciscus Gasthuis, Rotterdam, the Netherlands. 9. The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide and The South Australian Health and Medical Research Institute, Adelaide, Australia. 10. Department of Health Sciences, Faculty of Earth and Life Sciences, Free University Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
Abstract
INTRODUCTION: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown. MATERIAL AND METHODS:From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost-utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping. RESULTS: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage vs. 83% of the women after expectant management (mean difference 13%, 95% confidence interval 5-20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95% C confidence interval €955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. CONCLUSIONS: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.
RCT Entities:
INTRODUCTION: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown. MATERIAL AND METHODS: From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost-utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping. RESULTS: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage vs. 83% of the women after expectant management (mean difference 13%, 95% confidence interval 5-20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95% C confidence interval €955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. CONCLUSIONS: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.
Authors: Pushplata Kumari; R N Preethi; Anuja Abraham; Swati Rathore; Santosh Benjamin; M Gowri; Jiji Elizabeth Mathews Journal: J Family Med Prim Care Date: 2019-12-10
Authors: Charlotte C Hamel; Marcus P L M Snijders; Sjors F P J Coppus; Frank P H A Vandenbussche; Didi D M Braat; Eddy M M Adang Journal: PLoS One Date: 2022-02-09 Impact factor: 3.240
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