A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss
Open accessAbstract
Objective To determine the cost-effectiveness of medical and surgical management of early pregnancy loss.Design Analyses of cost, effectiveness, and incremental cost-effectiveness ratios and utilities of a multicenter trial with 652 women with first-trimester pregnancy failure randomized to medical or surgical management.Setting Analysis of data from a multicenter trial.Patient(s) Secondary analysis of a multicenter trial.Intervention(s) Cost-effectiveness analysis.Main outcome measure(s) Cost and effectiveness of competing treatment strategies.Result(s) Cost analysis of treatment demonstrates an increased cost of US$336 for 13% increased efficacy of surgical management. This analysis was sensitive to the probability of an extra office visit, the cost of the visit, and the probability of success. When the surgical arm is divided into outpatient manual vacuum aspiration (MVA) versus inpatient electric vacuum aspiration (EVA), there is an increased cost of $745 for EVA but a decreased cost of $202 for MVA compared with medical management. In general, MVA was found to be more cost-effective than medical management. For treatment of incomplete or inevitable abortion, medical management was found to be less costly and more efficacious. Utilities studies demonstrated that a patient would need to prefer surgery 14% less than medication for its treatment efficacy to be outweighed by the desire to avoid surgery.Conclusion(s) Surgical or medical management of early pregnancy failure can be cost effective, depending on the circumstances. Surgery is cost effective and more efficacious when performed in an outpatient setting. For incomplete or inevitable abortion, medical management is cost effective and more efficacious.
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Women who experience recurrent miscarriage are themselves born with a significantly reduced birthweight.
“Women who experience recurrent miscarriage are themselves born with a significantly reduced birthweight, 102”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [102]
The Methods (Trial background; page unavailable) describe patients enrolled for management of early pregnancy loss, and the Discussion (page unavailable) compares treatment outcomes by miscarriage type. Neither passage addresses recurrent miscarriage in relation to the women's own birthweight; searches for that relationship and for low birthweight found no relevant passage in our copy. (LLM, conf=0.76)
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Early Pregnancy Failure: Medical versus Surgical Management
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- Authors
- Rausch, M., Lorch, S., Chung, K., Frederick, M., Zhang, J., & Barnhart, K.
- Affiliations
- North Shore University Hospital (US)
- Children's Hospital of Philadelphia (US)
- University of Southern California (US)
- Clinical Trials and Surveys Corporation (US)
- National Institutes of Health (US)
- University of Pennsylvania (US)
- Corresponding author
- Barnhart, Kurt
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 97
- Issue
- 2
- Pages
- 355-360.e1
- ISSN
- 0015-0282 (ISSN-L)
- PMC
- PMC3269545
- OpenAlex
- W1964143603
- Cited by
- 80
- References
- 23
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 8 · 2018: 8 · 2017: 9 · 2016: 4 · 2015: 10 · 2014: 7 · 2013: 3 · 2012: 2
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD060687, N01-HD-1-3324, N01-HD-1-3323, T32HD007440, N01-HD-1-3322, R01HD036455, N01-HD-1-3325, N01-HD 1-3321)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Keywords
- early pregnancy loss, miscarriage, cost-effectiveness, medical management, surgical management, manual vacuum aspiration, incomplete abortion, inevitable abortion, treatment efficacy, patient preferences
- MeSH terms
- Abortifacient Agents, Nonsteroidal, Abortion, Spontaneous, Abortion, Induced, Ambulatory Surgical Procedures, Cost-Benefit Analysis, Female, Humans, Office Visits, Pregnancy, Pregnancy Trimester, First, United States, Vacuum Curettage, Drug Costs, Misoprostol, Treatment Outcome, Health Care Costs, Hospital Costs, Models, Economic
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