title: The financial costs to patients of diagnosing and excluding ectopic pregnancy.
abstract: OBJECTIVE
  Health care costs are one of the greatest challenges in modern medicine. In gynaecology, diagnosing and excluding ectopic pregnancy (EP) has been shown to be a financial burden to health services because it commonly requires multiple investigations and hospital visits. However, the full economic costs are not captured by an analysis of health care costs alone. This study therefore aimed to assess the indirect costs to patients of diagnosing and excluding EP.
  
  
  METHODS
  Patients presenting to a Pregnancy Support Centre in a large UK teaching hospital with abdominal pain and/or bleeding and a positive pregnancy test were recruited during the period June 2010-February 2011. Patients were provided with questionnaires to be completed at home and designed to record and quantify costs that they had incurred until a final diagnosis of their condition was made. A cost-description analysis was performed.
  
  
  RESULTS
  52/203 (26%) recruited patients returned completed questionnaires. The mean cost to patients of diagnosing or excluding EP was £135.13±£51.60 (median £20.70). The main cost drivers identified were hospital visits, holiday cancellations, income loss and household help.
  
  
  CONCLUSIONS
  Quantification of the indirect costs of diagnosing and excluding EP is challenging because it relies on questionnaire feedback from patients at a time when they have suffered from the emotional impact of pregnancy loss. However, initial estimates suggest that such costs are significant due to diagnostic delays. This further highlights the importance of the development of potential biomarkers of EP to allow prompt diagnosis.
authors.affiliation: Specialist Trainee in Obstetrics and Gynaecology, East of Scotland Rotation, UK.
authors.forename: Holger W
authors.initials: HW
authors.lastname: Unger
authors.forename: Lisa
authors.initials: L
authors.lastname: Starrs
authors.forename: Linda
authors.initials: L
authors.lastname: Scott
authors.forename: Hilary O D
authors.initials: HO
authors.lastname: Critchley
authors.forename: W Colin
authors.initials: WC
authors.lastname: Duncan
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Horne
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D005102:Health Expenditures; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000191:economics; D012606:Scotland; D011795:Surveys and Questionnaires
keywords: health economics