title: Cost-effectiveness of dilation and evacuation versus the induction of labor for second-trimester pregnancy termination.
abstract: OBJECTIVE
  The purpose of this study was to compare the cost-effectiveness of dilation and evacuation versus misoprostol induction of labor for second-trimester termination.
  
  
  METHODS
  Using decision analysis, we compared the cost-effectiveness of dilation and evacuation and misoprostol induction of labor for second-trimester termination. Complications for dilation and evacuation and induction of labor included repeat dilation and curettage, cervical laceration repair, hospital admission, laparotomy, hysterectomy, and maternal death. Induction of labor complications also included failed induction of labor. The primary outcome was cost per quality-adjusted life year. Sensitivity analyses were performed for all relevant variables.
  
  
  RESULTS
  Dilation and evacuation was less costly and more effective than misoprostol induction of labor for second-trimester termination with baseline estimates. In 1-way sensitivity analysis, the model was robust to all variation in probabilities and costs. In Monte Carlo simulation with 1000 trials and a cost-effectiveness threshold of $50,000/quality-adjusted life year, dilation and evacuation was the preferred approach in 97.9% of trials.
  
  
  CONCLUSIONS
  Dilation and evacuation is less expensive and more effective than misoprostol induction of labor for second-trimester termination.
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Cowett
authors.forename: Robert M
authors.initials: RM
authors.lastname: Golub
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics* / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000191:economics* / Q000379:methods*; D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D004107:Dilatation and Curettage / Q000191:economics*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016595:Misoprostol / Q000191:economics* / Q000627:therapeutic use*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011788:Quality of Life
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol