title: Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.
abstract: OBJECTIVE
  The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss (EPL) treatment beyond expectant management and operating room surgical evacuation (usual care).
  
  
  METHODS
  We constructed a decision model using a hypothetical cohort of women undergoing EPL management within a 30 day horizon. Treatment options under the usual care arm include expectant management and surgical uterine evacuation in an operating room (OR). Treatment options under the expanded care arm included all evidence-based safe and effective treatment options for EPL: expectant management, misoprostol treatment, surgical uterine evacuation in an office setting, and surgical uterine evacuation in an OR. Probabilities of entering various treatment pathways were based on previously published observational studies.
  
  
  RESULTS
  The cost per case was US $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model (US $1033.29 per case vs US $1274.58 per case, expanded care and usual care, respectively). The model was the most sensitive to the failure rate of the expectant management arm, the cost of the OR surgical procedure, the proportion of women undergoing an OR surgical procedure under usual care, and the additional cost per patient associated with implementing and using the expanded care model.
  
  
  CONCLUSIONS
  This study demonstrates that expanding women's treatment options for EPL beyond what is typically available can result in lower direct medical expenditures.
authors.affiliation: Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. Electronic address: daltonvk@med.umich.edu.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.affiliation: Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, MI.
authors.forename: Angela
authors.initials: A
authors.lastname: Liang
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
authors.affiliation: Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, MI.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Zochowski
authors.affiliation: Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics* / Q000627:therapeutic use; D000022:Abortion, Spontaneous / Q000191:economics* / Q000628:therapy; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D004107:Dilatation and Curettage / Q000191:economics* / Q000379:methods; D019317:Evidence-Based Medicine / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016595:Misoprostol / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D009873:Operating Rooms / Q000191:economics; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D057832:Watchful Waiting
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: decision model; early pregnancy loss treatment; office procedures