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Hum. Reprod. Advance Access published online on June 24, 2005
Human Reproduction, doi:10.1093/humrep/dei163
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Received April 25, 2005
Revised May 19, 2005
Accepted May 24, 2005

Article

Expectant, medical or surgical treatment for spontaneous abortion in first trimester of pregnancy: a cost analysis

Joyce H.S. You 1* and Tony K.H. Chung 1

1 Centre for Pharmacoeconomics Research, School of Pharmacy, Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong

* To whom correspondence should be addressed.
Joyce H.S. You, E-mail: joyceyou{at}cuhk.edu.hk


  Abstract

BACKGROUND: Misoprostol and expectant care have been shown to be acceptable alternatives to routine surgical evacuation for treatment of spontaneous abortion in the first trimester of pregnancy. The objective of this study was to analyse the cost of expectant care, misoprostol therapy and surgical evacuation. METHODS: A decision tree was designed to simulate the clinical outcome and health care resource utilization of surgical evacuation, misoprostol and expectant care for patients presenting with uncomplicated spontaneous abortion in the first trimester of pregnancy. Clinical inputs were estimated from literature and the cost analysis was conducted from the perspective of a public health care provider in Hong Kong. RESULTS: The base-case analysis showed that the misoprostol group (US\$1000 per patient) was the least costly alternative, followed by the expectant care (US\$1172 per patient) and surgical evacuation (US\$2007 per patient). Rates of complete abortion using misoprostol and expectant care were identified as influential factors. Monte Carlo simulation (10 000 cohorts) showed that the misoprostol and the expectant care groups were less costly than the surgical evacuation group 100 and 88% of the time. The misoprostol group was less costly than the expectant group 100% of the time. CONCLUSIONS: Misoprostol therapy appears to be the least costly approach for treatment of uncomplicated spontaneous abortion.

Keywords: cost analysis/expectant care/misoprostol/spontaneous abortion/surgical evacuation.
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