Management strategies for abnormal early pregnancy: a cost-effectiveness analysis.
OBJECTIVE
To assess the potential effectiveness and costs of 4 commonly used strategies to manage abnormal early pregnancies (AEPs).


METHODS
A decision analysis model was constructed to compare 4 strategies to manage AEPs: (1) observation, (2) medical management, (3) manual vacuum aspiration (MVA), and (4) dilation and curettage (D&C).


RESULTS
MVA was the most cost-effective strategy, at dollar 793 per cure, for a total cost of dollar 377 million per 500,000 women and a cure rate of 95%. D&C was more effective than MVA, with a cure rate of 99%, but was more expensive (dollar 2,333 per cure, for a total cost of dollar 1.2 billion). D&C cured 20,000 more patients than MVA; however, at a substantial cost of dollar 38,925 per additional cure. With other estimates at baseline, MVA remained more cost-effective than D&C until the efficacy of MVA was < 82% or the cost of D&C was < dollar 240.


CONCLUSIONS
MVA is the most cost-effective strategy for managing AEP and would be appropriate in settings in which resources are limited. D&C remains a reasonable strategy; however, one must spend dollar 38,925 per additional cure. In the United States, MVA would save dollar 779 million per year relative to D&C.
Rocconi
Rodney P
RP
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham 35233, USA. rocconi@uab.edu
Chiang
Seine
S
Richter
Holly E
HE
Straughn
J Michael
JM
D000019:Abortifacient Agents / Q000008:administration & dosage / Q000191:economics; D000028:Abortion, Induced / Q000191:economics / Q000379:methods; D000022:Abortion, Spontaneous / Q000628:therapy*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004107:Dilatation and Curettage / Q000191:economics / Q000379:methods; D020964:Embryo Loss / Q000628:therapy; D005260:Female; D005313:Fetal Death / Q000628:therapy*; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000191:economics* / Q000379:methods; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014619:Vacuum Curettage / Q000191:economics / Q000379:methods
D000019:Abortifacient Agents