Treating Miscarriages: A Randomized Study of Cost-Effectiveness in Medical or Surgical Choice

Le résumé fourni par la source

Miscarriage occurs in up to 15% of women with a history of at least 1 miscarriage during their reproductive life span. A meta-analysis reported that treatment of miscarriage surgically was considerably more effective than medical or expectant management when complete abortion was the main outcome. Results of 3 previous studies had suggested that costs associated with medical treatment were lower than with surgical treatment. However, a qualitative study comparing medical, surgical and expectant management reported that no single method was the best choice for all women. The present study was performed to compare the cost effectiveness of medical and surgical treatment of miscarriage, using both quantitative and qualitative indicators to assess the effectiveness of treatment. Quantitative indicators used were the success of treatment without unplanned curettage. Qualitative indicators were patient self-reports of the experience of pain and satisfaction with treatment. The study data was obtained from a previous randomized trial in which 98 women with a diagnosed miscarriage had been randomized to receive either medical or surgical treatment. Successful treatment was defined as no need for subsequent interventions (curettage) after the primary treatment. The incremental cost-effectiveness ratio was used to measure the additional costs for achieving an extra unit of effectiveness and was calculated by dividing the total costs by the effectiveness of treatment. The primary outcome measure was the costs of uncomplicated treatment. Secondary outcome measures were added costs from complications and other unplanned events during management. The primary costs of medical treatment of miscarriage were lower in the medical treatment group than in the surgical treatment group. However, after addition of costs associated with managing complications and other unplanned events, there was no difference in total costs between the groups. Incremental cost-effectiveness ratio analysis showed that, compared to the surgical group, the medical group had 12 more patients experiencing pain, 7 more dissatisfied with the treatment, and 5 more with unsuccessful treatment. The investigators suggested that these negative outcomes may have been avoided by investing an additional €1688 in surgical treatment. These findings show that there is no difference between the cost-effectiveness of medical and surgical management when both primary costs of treating miscarriage and the added costs resulting from adverse events are considered. Accordingly, the investigators conclude that choice of management should be based largely on patient preferences.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.