Women's preferences for attributes of first-trimester miscarriage management: a stated preference discrete-choice experiment
Open accessAbstract
Objective To elicit women's preferences for attributes of alternative management options for first-trimester miscarriage.Methods A stated preference discrete-choice experiment was conducted among 1198 women with a confirmed pregnancy of less than 13 weeks gestation, who had been diagnosed with either an incomplete miscarriage or missed miscarriage/early fetal demise and who had been recruited as part of a randomized controlled trial (miscarriage treatment [MIST] trial) comparing expectant, medical, and surgical miscarriage. Six attributes, each with three or four levels, were used in the statistical design. An orthogonal main effects design was generated (i.e., a design where the attributes are independent of each other) and the choice sets devised according to the principles of minimum overlap and level balance. A cost attribute was included to allow estimation of willingness to pay (WTP) values. Three different questionnaires were designed such that women were asked their preferences for attributes of the two management options they had not been allocated to in the trial.Results A total of 630 women completed the stated preference discrete-choice survey questionnaires: 189 out of 398 women (47.5%) allocated to expectant management, 223 out of 398 women (56.0%) allocated to medical management, and 218 out of 402 women (54.2%) allocated to surgical management. For each of the three discrete-choice survey questionnaires, women expressed a clear preference for decreased levels of all six attributes (time spent at the hospital receiving treatment, level of pain experienced, number of days of bleeding after treatment, time taken to return to normal activities after treatment, cost of treatment to women, and chance of complications requiring more time or readmission to hospital). For each of the three discrete-choice survey questionnaires, the highest valued attribute in terms of WTP was for a reduction in pain levels followed by time taken to return to normal activities after treatment. On aggregate, surgical management was valued more highly than expectant and medical management by women allocated to medical and expectant management, respectively, and medical management was valued more highly than expectant management by women allocated to surgical management. This held true regardless of the application of either hypothetical data for each attribute generated by the pretrial-designed discrete-choice experiment questionnaires or actual data for each attribute observed in the MIST trial.Conclusions The preference results generated by this study suggest that many women undergoing management of first-trimester miscarriage would value being offered alternatives to expectant management. The data from this study should be considered by decision-makers in conjunction with the clinical and cost-effectiveness evidence base in this area as well as consideration of the budgets available to them for such services.
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Most published studies aimed to provide information about options less costly than current practice or to probe the value of adjuncts to current practice.
“Most published studies have aimed to provide information about options that are less costly than current practice, 111-118 or to probe the value of adjuncts to current practice. 119”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [115]
Unit cost estimates in published studies have been derived from primary research methods and administrative tariffs.
“Unit costs estimates have been derived from a number of sources, including primary research methods 113,115,116 and administrative tariffs. 120,121”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [115]
In Pakistan, electrical vacuum aspiration was estimated to cost £193.
“electrical vacuum aspiration £193, 115,116”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [115]
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- Authors
- Petrou, S., & McIntosh, E.
- Affiliations
- University of Oxford (GB)
- Venue
- Value in Health
- Publisher
- Elsevier BV
- Published
- 2009-06
- Volume
- 12
- Issue
- 4
- Pages
- 551-559
- ISSN
- 1098-3015 (ISSN-L)
- OpenAlex
- W2028923916
- Cited by
- 58
- References
- 37
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 1
- FWCI
- 8.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Value in Health (publishedVersion)
- PubMed (publishedVersion)
- Oxford University Research Archive (ORA) (University of Oxford) (acceptedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- first-trimester miscarriage, miscarriage management, expectant management, medical management, surgical management, patient preferences, willingness to pay, pain, treatment costs, return to normal activity, missed abortion, incomplete abortion, preference heterogeneity, hospital readmission, time to return to work
- MeSH terms
- Abortion, Spontaneous, Adult, Choice Behavior, Decision Making, Decision Support Techniques, Female, Humans, Pregnancy, Pregnancy Trimester, First, Surveys and Questionnaires, Confidence Intervals, Health Care Surveys, Resource Allocation, Patient Preference
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