Medical management of early pregnancy loss is cost-effective compared with office uterine aspiration

• Published in: American journal of obstetrics and gynecology 2022-11, Vol.227 (5), p.737.e1-737.e11
• Main Authors: Nagendra, Divyah, Gutman, Sarah M., Koelper, Nathanael C., Loza-Avalos, Sandra E., Sonalkar, Sarita, Schreiber, Courtney A., Harvie, Heidi S.
• Format: Article
• Language: English
• Subjects: Abortion, Spontaneous - drug therapy; Cost-Benefit Analysis; Drug Therapy, Combination; Female; health economics; Humans; Mifepristone - therapeutic use; mifepristone pretreatment; miscarriage; misoprostol; Misoprostol - therapeutic use; Pregnancy; quality-adjusted life-years; uterine aspiration
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2022.06.054

Early pregnancy loss, also referred to as miscarriage, is common, affecting approximately 1 million people in the United States annually. Early pregnancy loss can be treated with expectant management, medications, or surgical procedures—strategies that differ in patient experience, effectiveness, and cost. One of the medications used for early pregnancy loss treatment, mifepristone, is uniquely regulated by the Food and Drug Administration. This study aimed to compare the cost-effectiveness from the healthcare sector perspective of medical management of early pregnancy loss, using the standard of care medication regimen of mifepristone and misoprostol, with that of office uterine aspiration. We developed a decision analytical model to compare the cost-effectiveness of early pregnancy loss treatment with medical management with that of office uterine aspiration. Data on medical management came from the Pregnancy Failure Regimens randomized clinical trial, and data on uterine aspiration came from the published literature. The analysis was from the healthcare sector perspective with a 30-day time horizon. Costs were in 2018 US dollars. Effectiveness was measured in quality-adjust life-years gained and the rate of complete gestational sac expulsion with no additional interventions. Our primary outcome was the incremental cost per quality-adjust life-year gained. Sensitivity analysis was performed to identify the key uncertainties. Mean per-person costs were higher for uterine aspiration than for medical management ($828 [95% confidence interval, $789–$868] vs $661 [95% confidence interval, $556–$766]; P=.004). Uterine aspiration more frequently led to complete gestational sac expulsion than medical management (97.3% vs 83.8%; P=.0001); however, estimated quality-adjust life-years were higher for medical management than for uterine aspiration (0.082 [95% confidence interval, 0.8148–0.08248] vs 0.079 [95% confidence interval, 0.0789–0.0791]; P