Expectant, medical or surgical treatment for spontaneous abortion in first trimester of pregnancy: a cost analysis
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 (1000 US dollars per patient) was the least costly alternative, followed by the expectant care (1172 US dollars per patient) and surgical evacuation (2007 US dollars per patient). Rates of complete abortion using misoprostol and expectant care were identified as influential factors. Monte Carlo simulation (10000 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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is growing evidence that preterm infants born after spontaneous preterm labour have a lower mean birthweight than what would be expected for their gestation.
“There is growing evidence that preterm infants born after spontaneous preterm labour have a lower mean birthweight than what would be expected for their gestation. 104-106”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [106]
Cites
Expectant management of first-trimester spontaneous abortion
Nielsen, S., & Hahlin, M. (1995) · The Lancet · doi:10.1016/s0140-6736(95)90060-8 · Cited by 245 · see citing works
Outcome of expectant management of spontaneous first trimester miscarriage: observational study
Luise, C., Jermy, K., May, C., Costello, G., Collins, W. P., & Bourne, T. H. (2002) · BMJ · doi:10.1136/bmj.324.7342.873 · Cited by 228 · see citing works
Bagratee, J. S. (2004) · Human Reproduction · doi:10.1093/humrep/deh049 · Cited by 165 · see citing works
Expectant, Medical, or Surgical Management of First-Trimester Miscarriage: A Meta-Analysis
Sotiriadis, A., Makrydimas, G., Papatheodorou, S., & Ioannidis, J. P. A. (2005) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000158857.44046.a4 · Cited by 158 · see citing works
Expectant care versus surgical treatment for miscarriage
Nanda, K., Lopez, L. M., Grimes, D. A., Peloggia, A., & Nanda, G. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003518.pub3 · Cited by 151 · see citing works
CRITICAL ASSESSMENT OF DILATATION AND CURETTAGE IN 1029 WOMEN
MacKenzie, I. Z., & Bibby, J. G. (1978) · The Lancet · doi:10.1016/s0140-6736(78)92895-7 · Cited by 149 · see citing works
Demetroulis, C. (2001) · Human Reproduction · doi:10.1093/humrep/16.2.365 · Cited by 132 · see citing works
Misoprostol for Medical Evacuation of Early Pregnancy Failure
Creinin, M. D. (1997) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(97)81438-x · Cited by 127 · see citing works
Randomised trial comparing expectant with medical management for first trimester miscarriages
Nielsen, S., Hahlin, M., & Platz‐Christensen, J. (1999) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1999.tb08401.x · Cited by 126 · see citing works
Chung, T. K. H., Lee, D. T. S., Cheung, L. P., Haines, C. J., & Chang, A. M. Z. (1999) · Fertility and Sterility · doi:10.1016/s0015-0282(99)00128-4 · Cited by 122 · see citing works
Self-citationVaginal misoprostol as medical treatment for first trimester spontaneous miscarriage
Ngai, S. W. (2001) · Human Reproduction · doi:10.1093/humrep/16.7.1493 · Cited by 105 · see citing works
Medical management of missed abortion: a randomized clinical trial
Wood, S. L. (2002) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(01)01765-3 · Cited by 104 · see citing works
Expectant management of missed miscarriage
Jurkovic, D., Ross, J. A., & Nicolaides, K. H. (1998) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1998.tb10184.x · Cited by 92 · see citing works
Tang, O. S., Lau, W. N. T., Ng, E. H. Y., et al. (2003) · Human Reproduction · doi:10.1093/humrep/deg013 · Cited by 88 · see citing works
SHELLEY, J. M., HEALY, D., & GROVER, S. (2005) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2005.00357.x · Cited by 84 · see citing works
Wieringa-de Waard, M. (2002) · Human Reproduction · doi:10.1093/humrep/17.9.2445 · Cited by 81 · see citing works
Misoprostol in the management of spontaneous abortion
Chung, T. K. H., Cheung, L. P., Leung, T. Y., et al. (1995) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1995.tb10852.x · Cited by 78 · see citing works
Self-citationEarly intrauterine pregnancy failure: A randomized trial of medical versus surgical treatment
Muffley, P. E., Stitely, M. L., & Gherman, R. B. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.126205 · Cited by 70 · see citing works
Pang, M. W. (2001) · Human Reproduction · doi:10.1093/humrep/16.11.2283 · Cited by 60 · see citing works
The costs of treating miscarriage: a comparison of medical and surgical management
Hughes, J., Ryan, M., Hinshaw, K., Henshaw, R., Rispin, R., & Templeton, A. (1996) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1996.tb09632.x · Cited by 58 · see citing works
Graziosi, G. C. M., van der Steeg, J. W., Reuwer, P. H. W., Drogtrop, A. P., Bruinse, H. W., & Mol, B. W. J. (2005) · Human Reproduction · doi:10.1093/humrep/deh709 · Cited by 58 · see citing works
Spontaneous abortion rates after natural and assisted conception.
Steer, C., Campbell, S., Davies, M. C., et al. (1989) · BMJ · doi:10.1136/bmj.299.6711.1317 · Cited by 56 · see citing works
Medical management of early fetal demise using a combination of mifepristone and misoprostol
Wagaarachchi, P. T., Ashok, P. W., Narvekar, N. N., et al. (2001) · Human Reproduction · doi:10.1093/humrep/16.9.1849 · Cited by 56 · see citing works
Chung, T. K. H., Leung, P. C. K., Cheung, L. P., et al. (1997) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.3109/00016349709047804 · Cited by 52 · see citing works
Self-citationLee, D. T. S., Cheung, L. P., Haines, C. J., Chan, K., & Chung, T. K. H. (2001) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2001.117661 · Cited by 51 · see citing works
Self-citationSpontaneous Abortion: Short‐term Complications Following Either Conservative or Surgical Management
Chung, T. K. H., Cheung, L. P., Sahota, D. S., Haines, C. J., & Chang, A. M. Z. (1998) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.1998.tb02960.x · Cited by 43 · see citing works
Self-citationChung, T., Leung, P., Cheung, L. P., Haines, C., & Chang, A. M. Z. (1997) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.1997.tb07854.x · Cited by 41 · see citing works
Self-citationŞahin, H. G., SAHIN, H. A., & KOÇER, M. (2001) · The European Journal of Contraception & Reproductive Health Care · doi:10.1080/ejc.6.3.141.144 · Cited by 38 · see citing works
Gilles, J. M., Creinin, M. D., Barnhart, K. T., Westhoff, C. L., Frederick, M., & Zhang, J. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2003.08.024 · Cited by 35 · see citing works
Waard, M. W., Bindels, P., Vos, J., et al. (2004) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2003.07.004 · Cited by 33 · see citing works
Patient preferences for management of first-trimester incomplete spontaneous abortion.
Molnar, A. M., Oliver, L., & Geyman, J. P. (2001) · PubMed · Cited by 30 · see citing works
LaFerla, J. J. (1986) · Clinics in Obstetrics and Gynaecology · doi:10.1016/s0306-3356(21)00157-6 · Cited by 29 · see citing works
Waard, M. W., Ankum, W. M., Bonsel, G. J., Vos, J., Biewenga, P., & Bindels, P. (2003) · Europe PMC (PubMed Central) · Cited by 24 · see citing works
The treatment of incomplete miscarriage with oral misoprostol
Pandian, Z., Ashok, P. W., & Templeton, A. (2001) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2001.00024.x · Cited by 24 · see citing works
Expectant management of first‐trimester miscarriage in clinical practice
Blohm, F., Fridén, B. E., Platz‐Christensen, J., et al. (2003) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1034/j.1600-0412.2003.00192.x · Cited by 24 · see citing works
Medical management of first trimester incomplete miscarriage using misoprostol
Coughlin, L. B., Roberts, D., Haddad, N., et al. (2003) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443610310001620341 · Cited by 21 · see citing works
Leung, S. W., Pang, M. W., & Chung, T. K. H. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.04.024 · Cited by 20 · see citing works
Self-citationMedical management for miscarriage
Vazquez, J., Hickey, M., & Neilson, J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002253.pub2 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Quenby, S., Gallos, I. D., Dhillon-Smith, R. K., Podesek, M., Stephenson, M. D., Fisher, J., Brosens, J. J., Brewin, J., Ramhorst, R., Lucas, E. S., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00682-6 · Cited by 1,560 · see citing works
Hooker, A. B., Lemmers, M., Thurkow, A. L., Heymans, M. W., Opmeer, B. C., Brolmann, H. A. M., Mol, B. W., & Huirne, J. A. F. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmt045 · Cited by 478 · see citing works
A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss
Rausch, M., Lorch, S., Chung, K., Frederick, M., Zhang, J., & Barnhart, K. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.11.044 · Cited by 80 · see citing works
Lemmers, M., Verschoor, M. A. C., Bossuyt, P. M., Huirne, J. A. F., Spinder, T., Nieboer, T. E., Bongers, M. Y., Janssen, I. A. H., Van Hooff, M. H. A., Mol, B. W. J., et al. (2018) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13283 · Cited by 23 · see citing works
Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss
Dalton, V. K., Liang, A., Hutton, D. W., Zochowski, M. K., & Fendrick, A. M. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2014.08.031 · Cited by 22 · see citing works
- Authors
- You, J. H. S., & Chung, T. K. H.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- You, Joyce H.S.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-06-24
- Volume
- 20
- Issue
- 10
- Pages
- 2873-2878
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2147764549
- Cited by
- 80
- References
- 38
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 11 · 2022: 3 · 2021: 6 · 2020: 3 · 2019: 7 · 2018: 4 · 2017: 7 · 2016: 1 · 2015: 5 · 2014: 5 · 2013: 6 · 2012: 2
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Hong Kong
- Chinese University of Hong Kong
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- miscarriage, first trimester, expectant management, misoprostol, surgical evacuation, cost analysis, cost-effectiveness, complete abortion, healthcare resource utilization, decision tree
- MeSH terms
- Abortifacient Agents, Nonsteroidal, Abortion, Spontaneous, Cost-Benefit Analysis, Costs and Cost Analysis, Decision Trees, Dilatation and Curettage, Health Expenditures, Female, Humans, Monte Carlo Method, Pregnancy, Pregnancy Trimester, First, Sensitivity and Specificity, Time Factors, Misoprostol, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
