title: Economic evaluation of diagnosing and excluding ectopic pregnancy.
abstract: BACKGROUND
  The diagnosis of ectopic pregnancy in women presenting in early pregnancy is often protracted, relying on costly investigations that are psychologically burdensome to the patient. The aim of this study was to evaluate the financial costs to the health services in Scotland of the current methods used to diagnose and exclude ectopic pregnancy, and compare these with that of a theoretical single diagnostic serum biomarker.
  
  
  METHODS
  We conducted a retrospective cost-description analysis (with and without costs of diagnostic laparoscopy) of the health-care costs incurred by all patients presenting to a large Scottish teaching hospital between June and September 2006 with pain and bleeding in early pregnancy, where ectopic pregnancy was not excluded. Additionally, a cost minimization analysis was performed for the costs of current ectopic pregnancy investigations versus those of a theoretical single diagnostic serum biomarker. This included sensitivity analyses where the biomarker was priced at increasing values and assumed to have less than 100% diagnostic sensitivity and specificity.
  
  
  RESULTS
  About 175 patients were eligible to be included in the analysis. Forty-seven per cent of patients required more than three visits to diagnose or exclude ectopic pregnancy. The total yearly cost for diagnosing and excluding ectopic pregnancy was 197K pound sterling for the hospital stated, and was estimated to be 1364K pound sterling for Scotland overall. Using a theoretical diagnostic serum biomarker we calculated that we could save health services up to 976K pound sterling (lowest saving 251K pound sterling after subanalysis) every year in Scotland.
  
  
  CONCLUSIONS
  Ectopic pregnancy is expensive to diagnose and exclude, and the investigation process is often long and might involve significant psychological morbidity. The development of a single diagnostic serum biomarker would minimize this morbidity and lead to significant savings of up to 1 million pounds per year in Scotland.
authors.affiliation: Centre for Reproductive Biology, The University of Edinburgh, Edinburgh EH16 4TJ, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Wedderburn
authors.forename: P
authors.initials: P
authors.lastname: Warner
authors.forename: B
authors.initials: B
authors.lastname: Graham
authors.forename: W C
authors.initials: WC
authors.lastname: Duncan
authors.forename: H O D
authors.initials: HO
authors.lastname: Critchley
authors.forename: A W
authors.initials: AW
authors.lastname: Horne
mesh_terms: D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics* / Q000523:psychology; D012189:Retrospective Studies; D012606:Scotland; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human