title: Cost-effectiveness of presumptively medically treating women at risk for ectopic pregnancy compared with first performing a dilatation and curettage.
abstract: OBJECTIVE
  To compare the cost and complication rate of two alternative strategies for the diagnosis and medical management of ectopic pregnancy when ultrasound is nondiagnostic.
  
  
  METHODS
  A decision tree was constructed to compare [1] dilatation and curettage (D&C) followed by treatment of all ectopic pregnancies with methotrexate versus [2] empiric treatment of all patients with possible ectopic pregnancies with methotrexate without D&C.
  
  
  METHODS
  University setting.
  
  
  METHODS
  Ten thousand hypothetical women with nonviable pregnancies and a known incidence of ectopic pregnancy were entered into a computer model.
  
  
  METHODS
  The two approaches were compared with respect to the number of missed ectopic pregnancies, complications, procedures performed, admissions to the hospital, and cost.
  
  
  RESULTS
  The D&C group had 1% more failed managements of ectopic pregnancies and 13.4% fewer patients with a miscarriage undergo a second treatment for resolution. The D&C group had 13.7% fewer complications including 6.3% fewer hospitalizations. D&C costs $173 to $223 more than empiric use of methotrexate per patient.
  
  
  CONCLUSIONS
  Empirically treating women at risk for ectopic pregnancy with methotrexate does not reduce complications or save money. In the absence of such savings, the desire to make an accurate and definitive diagnosis, allowing objective prognosis on future fertility and risk of repeat ectopic pregnancy, supports the need to distinguish a miscarriage from ectopic pregnancy before treatment with methotrexate.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Ailawadi
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lorch
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Barnhart
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004107:Dilatation and Curettage / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008727:Methotrexate / Q000191:economics* / Q000627:therapeutic use; D017059:Models, Econometric; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications / Q000191:economics* / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate