title: Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis.
abstract: 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.
authors.affiliation: INSERM Unité 379, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Seror
authors.forename: Florent
authors.initials: F
authors.lastname: Gelfucci
authors.forename: Laurent
authors.initials: L
authors.lastname: Gerbaud
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pouly
authors.forename: Hervé
authors.initials: H
authors.lastname: Fernandez
authors.forename: Nadine
authors.initials: N
authors.lastname: Job-Spira
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
mesh_terms: 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
chemical_list: D008727:Methotrexate