1. Cost-effectiveness of curettage vs. expectant management in women with an incomplete evacuation after misoprostol treatment for first-trimester miscarriage: a randomized controlled trial and cohort study
- Author
-
Marianne A. C. Verschoor, Patrick M.M. Bossuyt, Marlies Y. Bongers, Willem M. Ankum, T. Spinder, Marcel H A Van Hooff, Judith E. Bosmans, Theodoor E. Nieboer, Judith A.F. Huirne, Ineke C. A. H. Janssen, Ben W.J. Mol, Marike Lemmers, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Health Economics and Health Technology Assessment, APH - Mental Health, APH - Methodology, Obstetrics and gynaecology, Amsterdam Reproduction & Development (AR&D), ACS - Atherosclerosis & ischemic syndromes, APH - Quality of Care, APH - Societal Participation & Health, Division 1, Other departments, Graduate School, APH - Personalized Medicine, Other Research, and Obstetrics and Gynaecology
- Subjects
Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,miscarriage ,ECONOMIC-EVALUATION ,Miscarriage ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,MIST TRIAL ,Prospective Studies ,030212 general & internal medicine ,Misoprostol ,curettage ,Expectant management ,Netherlands ,RISK ,030219 obstetrics & reproductive medicine ,Obstetrics ,Obstetrics and Gynecology ,Health Care Costs ,General Medicine ,Abortion, Incomplete ,Combined Modality Therapy ,Curettage ,Treatment Outcome ,SURGICAL-MANAGEMENT ,Female ,medicine.drug ,Cohort study ,Adult ,medicine.medical_specialty ,STRATEGIES ,SPONTANEOUS-ABORTION ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,MULTIPLE IMPUTATION ,All institutes and research themes of the Radboud University Medical Center ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,EARLY-PREGNANCY FAILURE ,Watchful Waiting ,METAANALYSIS ,misoprostol ,Abortifacient Agents, Nonsteroidal ,business.industry ,incomplete evacuation ,medicine.disease ,Confidence interval ,Pregnancy Trimester, First ,Cost-effectiveness ,business ,MEDICAL-MANAGEMENT ,Follow-Up Studies - Abstract
INTRODUCTION: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown.MATERIAL AND METHODS: From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost-utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping.RESULTS: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage vs. 83% of the women after expectant management (mean difference 13%, 95% confidence interval 5-20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95% C confidence interval €955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%.CONCLUSIONS: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.
- Published
- 2018
- Full Text
- View/download PDF