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
Year: 2017
Type: article
Study design: Clinical Trial
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.
DOI: 10.1111/aogs.13283
Authors: Marike Lemmers, Marianne A.C. Verschoor, Patrick M. Bossuyt, Judith A.F. Huirne, Teake Spinder, Theodoor E. Nieboer, Marlies Y. Bongers, Ineke A.H. Janssen, Marcel H.A. Van Hooff, Ben W.J. Mol, Willem M. Ankum, Judith E. Bosmans, on behalf of the MisoREST study group
Institutions: Amsterdam UMC Location University of Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Medisch Centrum Leeuwarden, Radboud University Medical Center, Maastricht University, Groene Hart Ziekenhuis, Sint Franciscus Gasthuis, South Australian Health and Medical Research Institute, The University of Adelaide, Amsterdam Public Health, Vrije Universiteit Amsterdam
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: ZonMw
Award: G2492509338
OpenAlex ID: W2780780487