Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City.
OBJECTIVE
To assess the comparative health and economic outcomes associated with three alternative first-trimester abortion techniques in Mexico City and to examine the policy implications of increasing access to safe abortion modalities within a restrictive setting.


METHODS
Cost-effectiveness analysis.


METHODS
Mexico City.


METHODS
Reproductive-aged women with unintended pregnancy seeking first-trimester abortion.


METHODS
Synthesising the best available data, a computer-based model simulates induced abortion and its potential complications and is used to assess the cost-effectiveness of alternative safe modalities for first-trimester pregnancy termination: (1) hospital-based dilatation and curettage (D&C), (2) hospital-based manual vacuum aspiration (MVA), (3) clinic-based MVA and (4) medical abortion using vaginal misoprostol.


METHODS
Number of complications, lifetime costs, life expectancy, quality-adjusted life expectancy.


RESULTS
In comparison to the magnitude of health gains associated with all safe abortion modalities, the relative differences between strategies were more pronounced in terms of their economic costs. Assuming all options were equally available, clinic-based MVA was the least costly and most effective. Medical abortion with misoprostol provided comparable benefits to D&C, but cost substantially less. Enhanced access to safe abortion was always more influential than shifting between safe abortion modalities.


CONCLUSIONS
This study demonstrates that the provision of safe abortion is cost-effective and will result in reduced complications, decreased mortality and substantial cost savings compared with unsafe abortion. In Mexico City, shifting from a practice of hospital-based D&C to clinic-based MVA and enhancing access to medical abortion will have the best chance to minimise abortion-related morbidity and mortality.
Hu
D
D
Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA. freeflap@gmail.com
Grossman
D
D
Levin
C
C
Blanchard
K
K
Goldie
S J
SJ
D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects / Q000191:economics; D000028:Abortion, Induced / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D000328:Adult; D003362:Cost-Benefit Analysis; D004107:Dilatation and Curettage / Q000009:adverse effects / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008800:Mexico; D016595:Misoprostol / Q000009:adverse effects / Q000191:economics; D017059:Models, Econometric; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D019057:Quality-Adjusted Life Years; D014619:Vacuum Curettage / Q000009:adverse effects / Q000191:economics
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol