title: A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss.
abstract: OBJECTIVE
  To determine the cost-effectiveness of medical and surgical management of early pregnancy loss.
  
  
  METHODS
  Analyses of cost, effectiveness, and incremental cost-effectiveness ratios and utilities of a multicenter trial with 652 women with first-trimester pregnancy failure randomized to medical or surgical management.
  
  
  METHODS
  Analysis of data from a multicenter trial.
  
  
  METHODS
  Secondary analysis of a multicenter trial.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Cost and effectiveness of competing treatment strategies.
  
  
  RESULTS
  Cost analysis of treatment demonstrates an increased cost of US$336 for 13% increased efficacy of surgical management. This analysis was sensitive to the probability of an extra office visit, the cost of the visit, and the probability of success. When the surgical arm is divided into outpatient manual vacuum aspiration (MVA) versus inpatient electric vacuum aspiration (EVA), there is an increased cost of $745 for EVA but a decreased cost of $202 for MVA compared with medical management. In general, MVA was found to be more cost-effective than medical management. For treatment of incomplete or inevitable abortion, medical management was found to be less costly and more efficacious. Utilities studies demonstrated that a patient would need to prefer surgery 14% less than medication for its treatment efficacy to be outweighed by the desire to avoid surgery.
  
  
  CONCLUSIONS
  Surgical or medical management of early pregnancy failure can be cost effective, depending on the circumstances. Surgery is cost effective and more efficacious when performed in an outpatient setting. For incomplete or inevitable abortion, medical management is cost effective and more efficacious.
authors.affiliation: North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Rausch
authors.forename: Scott
authors.initials: S
authors.lastname: Lorch
authors.forename: Karine
authors.initials: K
authors.lastname: Chung
authors.forename: Margaret
authors.initials: M
authors.lastname: Frederick
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Kurt
authors.initials: K
authors.lastname: Barnhart
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics* / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000191:economics*; D000022:Abortion, Spontaneous / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D000556:Ambulatory Surgical Procedures / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D016595:Misoprostol / Q000191:economics* / Q000627:therapeutic use*; D018803:Models, Economic; D009819:Office Visits / Q000191:economics; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016896:Treatment Outcome; D014481:United States; D014619:Vacuum Curettage / Q000191:economics*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol