TY - JOUR
T1 - 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
T2 - a randomized controlled trial and cohort study
AU - on behalf of the MisoREST study group
AU - Lemmers, Marike
AU - Verschoor, Marianne A. C.
AU - Bossuyt, Patrick M.
AU - Huirne, Judith A. F.
AU - Spinder, Teake
AU - Nieboer, Theodoor E.
AU - Bongers, Marlies Y.
AU - Janssen, Ineke A. H.
AU - van Hooff, Marcel H. A.
AU - Mol, Ben W. J.
AU - Ankum, Willem M.
AU - Bosmans, Judith E.
PY - 2018/3
Y1 - 2018/3
N2 - 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.
AB - 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.
KW - Cost-effectiveness
KW - curettage
KW - incomplete evacuation
KW - miscarriage
KW - misoprostol
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UR - https://www.ncbi.nlm.nih.gov/pubmed/29266169
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U2 - https://doi.org/10.1111/aogs.13283
DO - https://doi.org/10.1111/aogs.13283
M3 - Article
C2 - 29266169
SN - 0001-6349
VL - 97
SP - 294
EP - 300
JO - Acta obstetricia et gynecologica Scandinavica
JF - Acta obstetricia et gynecologica Scandinavica
IS - 3
ER -