Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management
Source: Human Reproduction, Volume 20, Number 4, April 2005 , pp. 1067-1071(5)
Publisher: Oxford University Press
Abstract: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.
Document Type: Research article
Affiliations: 1: Department of Obstetrics and Gynaecology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 2: Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, Amsterdam, 3: Department of Obstetrics and Gynaecology, St Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, 4: Department of Obstetrics and Gynaecology, Tweesteden Hospital, Dr Deelenlaan 5, Tilburg, 5: Department of Obstetrics and Gynaecology, University Medical Centre, Heidelberglaan 100, Utrecht and
Publication date: 2005-04-01
- Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues. The highest scientific and editorial standard is maintained throughout the journal along with a rapid rate of publication.