Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis
Open accessAbstract
BACKGROUND: Traditionally the gold-standard technique for the treatment of spontaneous abortion has been uterine evacuation by aspiration curettage. However, many studies have proposed medical treatment with misoprostol as an alternative to the conventional surgical treatment. The aim of this study was to apply cost minimization methods to compare the cost and effectiveness of the use of vaginal misoprostol as a medical treatment for first trimester spontaneous abortion with those of evacuation curettage as a surgical treatment. METHODOLOGY/PRINCIPAL FINDINGS: We present a longitudinal, prospective and quasi-experimental research study including a total of 547 patients diagnosed with first-trimester spontaneous abortion, in the period from January 2013 to December 2015. Patients were offered medical treatment with 800 mg vaginal misoprostol or evacuation curettage. Patients treated with misoprostol were followed-up at 7 days and a transvaginal ultrasound was performed to confirm the success of the treatment. If it failed, a second dose of 800 mg of vaginal misoprostol was prescribed and a new control ultrasound was performed. In case of failure of medical treatment after the second dose of misoprostol, evacuation curettage was indicated. The effectiveness of each of the treatment options was calculated using a decision tree. The cost minimization study was carried out by weighting each cost according to the effectiveness of each branch of the treatment. Of the 547 patients who participated in the study, 348 (64%) chose medical treatment and 199 (36%) chose surgical treatment. The overall effectiveness of medical treatment was 81% (283/348) and surgical treatment of 100%. The estimated final cost for medical treatment was € 461.92 compared to € 2038.72 for surgical treatment, which represents an estimated average saving per patient of € 1576.8. CONCLUSIONS/SIGNIFICANCE: Medical treatment with misoprostol is a cheaper alternative to surgery: in the Spanish Public Healthcare System, it is five times more inexpensive than curettage. Given its success rates higher than 80%, mild side effects, controllable with additional medication and the high degree of overall satisfaction, it should be prioritized over the evacuation curettage in patients who meet the treatment criteria.
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Ultrasound diagnosis of intrauterine haematoma (IUH) is associated with an increased risk of preeclampsia (RR 4.0; 95% CI 2.4-6.7), placental abruption (RR 5.6; 95% CI 2.8-11.1) and preterm delivery (RR 2.3; 95% CI 1.6-3.2).
“Ultrasound diagnosis of intrauterine haematoma (IUH) is also associated with an increased risk of antenatal complications such as preeclampsia (Relative Risk [RR] 4·0; 95% CI 2·4-6·7), placental abruption (RR 5·6; 95% CI 2·8-11·1) and preterm delivery (RR 2·3; 95% CI 1·6-3·2). 99”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [99]
The Inclusion and exclusion criteria section discusses ultrasound confirmation of pregnancy loss, and the Discussion addresses treatment outcomes and costs; neither addresses intrauterine haematoma or later antenatal complications. Searches for intrauterine haematoma, subchorionic hematoma, the named complications, and the reported risk ratios found no supporting passage in our copy. Page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEvents in early pregnancy have a significant impact on pregnancy outcomes.
“It is increasingly clear that events in early pregnancy have a significant impact on pregnancy outcomes. 97-100”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [99]
The Introduction (page unavailable) describes how often spontaneous abortion occurs early in pregnancy, while the study compares treatments after early pregnancy loss. Searches for early-pregnancy events affecting subsequent pregnancy outcomes found no passage addressing that relationship in our copy. (LLM, conf=0.70)
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References 20 · Cited by 41
Research works printed but not linked: 16
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- Authors
- Cubo Nava, A., Soto Pino, Z. M., Haro Pérez, A. M., Hernández Hernández, M. E., Doyague Sánchez, M. J., & Sayagués Manzano, J. M.
- ORCID
- Cubo Nava, Ana
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-01-10
- Volume
- 14
- Issue
- 1
- Pages
- e0210449
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6328124
- OpenAlex
- W2910093182
- Cited by
- 41
- References
- 20
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 2 · 2019: 3 · 2015: 1
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-03-29)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Gredos (University of Salamanca) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Hispana (submittedVersion, cc-by-nc-nd)
- Funders
- The Institute for Biomedical Research (IBSAL), Salamanca, Spain.
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- first-trimester spontaneous abortion, misoprostol, vaginal misoprostol, uterine evacuation, surgical versus medical treatment, cost minimization, treatment effectiveness, cost-effectiveness
- MeSH terms
- Abortifacient Agents, Nonsteroidal, Abortion, Spontaneous, Adult, Costs and Cost Analysis, Female, Humans, Longitudinal Studies, Pregnancy, Pregnancy Trimester, First, Prospective Studies, Misoprostol
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