Document Detail


A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss.
MedLine Citation:
PMID:  22192348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Mary Rausch; Scott Lorch; Karine Chung; Margaret Frederick; Jun Zhang; Kurt Barnhart
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2011-12-21
Journal Detail:
Title:  Fertility and sterility     Volume:  97     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-31     Completed Date:  2012-03-13     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  United States    
Other Details:
Languages:  eng     Pagination:  355-60     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Abortifacient Agents, Nonsteroidal / economics*,  therapeutic use*
Abortion, Induced / economics*
Abortion, Spontaneous / drug therapy,  economics*,  surgery,  therapy*
Ambulatory Surgical Procedures / economics
Cost-Benefit Analysis
Drug Costs
Female
Health Care Costs*
Hospital Costs
Humans
Misoprostol / economics*,  therapeutic use*
Models, Economic
Office Visits / economics
Pregnancy
Pregnancy Trimester, First
Treatment Outcome
United States
Vacuum Curettage / economics*
Grant Support
ID/Acronym/Agency:
K24 HD060687/HD/NICHD NIH HHS; K24 HD060687-04/HD/NICHD NIH HHS; K24HD060687/HD/NICHD NIH HHS; N01-HD-1-3321/HD/NICHD NIH HHS; N01-HD-1-3322/HD/NICHD NIH HHS; N01-HD-1-3323/HD/NICHD NIH HHS; N01-HD-1-3324/HD/NICHD NIH HHS; N01-HD-1-3325/HD/NICHD NIH HHS; R01 HD036455/HD/NICHD NIH HHS; R01 HD036455-10/HD/NICHD NIH HHS; R01-HD036455/HD/NICHD NIH HHS; T32-HD007440/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 0E43V0BB57/Misoprostol
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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