Expectant, medical or surgical treatment for spontaneous abortion in first trimester of pregnancy: a cost analysis.
BACKGROUND
Misoprostol and expectant care have been shown to be acceptable alternatives to routine surgical evacuation for treatment of spontaneous abortion in the first trimester of pregnancy. The objective of this study was to analyse the cost of expectant care, misoprostol therapy and surgical evacuation.


METHODS
A decision tree was designed to simulate the clinical outcome and health care resource utilization of surgical evacuation, misoprostol and expectant care for patients presenting with uncomplicated spontaneous abortion in the first trimester of pregnancy. Clinical inputs were estimated from literature and the cost analysis was conducted from the perspective of a public health care provider in Hong Kong.


RESULTS
The base-case analysis showed that the misoprostol group (1000 US dollars per patient) was the least costly alternative, followed by the expectant care (1172 US dollars per patient) and surgical evacuation (2007 US dollars per patient). Rates of complete abortion using misoprostol and expectant care were identified as influential factors. Monte Carlo simulation (10000 cohorts) showed that the misoprostol and the expectant care groups were less costly than the surgical evacuation group 100 and 88% of the time. The misoprostol group was less costly than the expectant group 100% of the time.


CONCLUSIONS
Misoprostol therapy appears to be the least costly approach for treatment of uncomplicated spontaneous abortion.
Centre for Pharmacoeconomics Research, School of Pharmacy, Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT. joyceyou@cuhk.edu.hk
Joyce H S
JH
You
Tony K H
TK
Chung
D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics / Q000494:pharmacology; D000022:Abortion, Spontaneous / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003663:Decision Trees; D004107:Dilatation and Curettage / Q000191:economics; D005260:Female; D005102:Health Expenditures; D006801:Humans; D016595:Misoprostol / Q000191:economics / Q000494:pharmacology; D009010:Monte Carlo Method; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol