Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis.
OBJECTIVE
To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness.


METHODS
Population-based cost-effectiveness study.


METHODS
Auvergne EP registry (France).


METHODS
Women (n = 1,664) registered between 1994 and 2003.


METHODS
Standard diagnosis and treatment of EP.


METHODS
Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system.


RESULTS
Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure.


CONCLUSIONS
Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness.
Seror
Valérie
V
INSERM Unité 379, Institut Paoli-Calmettes, Marseille, France.
Gelfucci
Florent
F
Gerbaud
Laurent
L
Pouly
Jean-Luc
JL
Fernandez
Hervé
H
Job-Spira
Nadine
N
Bouyer
Jean
J
Coste
Joël
J
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D005298:Fertility; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D014463:Ultrasonography
D008727:Methotrexate