title: Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?
abstract: BACKGROUND
  There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP), especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate.
  
  
  METHODS
  We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1) investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2) to compare the cost of medical management for women with hCG concentrations 1500-3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1) those who had initial medical management with methotrexate, (2) those who were eligible for initial medical management but chose surgery ('elected' surgery) and (3) those who initially 'required' surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS) in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method.
  
  
  RESULTS
  Methotrexate was £1179 (CI 819-1550) per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures.
  
  
  CONCLUSIONS
  Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.
authors.affiliation: MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Westaby
authors.forename: Olivia
authors.initials: O
authors.lastname: Wu
authors.forename: W Colin
authors.initials: WC
authors.lastname: Duncan
authors.forename: Hilary O D
authors.initials: HO
authors.lastname: Critchley
authors.forename: Stephen
authors.initials: S
authors.lastname: Tong
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Horne
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D006113:United Kingdom
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate