Early abortion in Ontario: options and costs.
OBJECTIVE
Early abortions have been predominantly surgical for many years, but medical options with comparable efficacy and safety are now available. This study compares the costs of two medical options and two surgical options.


METHODS
We used a clinical model to compare the costs in Ontario of four options for early abortion: medical abortion using either mifepristone or methotrexate, and surgical abortion by vacuum aspiration in either a hospital or a free-standing clinic. The cost analysis was conducted from the perspectives of society, the health care system, and the patient.


RESULTS
From all perspectives, total costs were highest for hospital surgical abortion, followed by surgical abortion in a clinic. From the patient's perspective, total costs were higher for surgical abortion but direct costs (mainly for medications) were higher for medical abortion. The total cost of mifepristone and methotrexate abortion was equal if the price of mifepristone (200 mg) was $59.52. The model was robust but was sensitive to the price of mifepristone.


CONCLUSIONS
Early medical abortion costs less than early surgical abortion from the societal and health care system perspectives but more than surgical abortion from the patient's perspective. Surgical abortion costs more in hospitals than in free-standing clinics from the societal and health care system perspectives, but the costs are the same in both settings from the patient's perspective. No method for early abortion can be identified as best, and patients should be free to choose the option they prefer.
Limacher
James J
JJ
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto ON.
Daniel
Imtiaz
I
Isaacksz
Shiran
S
Payne
Gregory J
GJ
Dunn
Sheila
S
Coyte
Peter C
PC
Laporte
Audrey
A
D000021:Abortifacient Agents, Steroidal / Q000191:economics* / Q000494:pharmacology; D000028:Abortion, Induced / Q000191:economics* / Q000379:methods*; D000554:Ambulatory Care Facilities / Q000191:economics; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000191:economics / Q000494:pharmacology; D015735:Mifepristone / Q000191:economics / Q000494:pharmacology; D009864:Ontario; D010044:Outpatient Clinics, Hospital / Q000191:economics; D011247:Pregnancy; D014619:Vacuum Curettage / Q000191:economics* / Q000379:methods
D000021:Abortifacient Agents, Steroidal; D015735:Mifepristone; D008727:Methotrexate