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

被引：10

作者：

Lemmers, Marike ^{[1
,2
]}

Verschoor, Marianne A. C. ^{[1
]}

Bossuyt, Patrick M. ^{[3
]}

Huirne, Judith A. F. ^{[2
]}

Spinder, Teake ^{[4
]}

Nieboer, Theodoor E. ^{[5
]}

Bongers, Marlies Y. ^{[6
]}

Janssen, Ineke A. H. ^{[7
]}

Van Hooff, Marcel H. A. ^{[8
]}

Mol, Ben W. J. ^{[9
,10
]}

Ankum, Willem M. ^{[1
]}

Bosmans, Judith E. ^{[11
]}

机构：

[1] Acad Med Ctr, Dept Obstet & Gynecol, POB 22770, NL-1100 DE Amsterdam, Netherlands

[2] Vrije Univ Amsterdam Med Ctr, Dept Obstet & Gynecol, Amsterdam, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Clin Res Unit, Amsterdam, Netherlands

[4] Leeuwarden Med Ctr, Dept Obstet & Gynecol, Leeuwarden, Netherlands

[5] Radboud Univ Nijmegen, Dept Obstet & Gynecol, Med Ctr, Nijmegen, Netherlands

[6] Maastricht Univ, Dept Obstet & Gynecol, Grow Sch Oncol & Dev Biol, Maastricht, Netherlands

[7] Groene Hart Hosp, Dept Obstet & Gynecol, Gouda, Netherlands

[8] St Franciscus Gasthuis, Dept Obstet & Gynecol, Rotterdam, Netherlands

[9] Univ Adelaide, Robinson Res Inst, Sch Pediat & Reprod Hlth, Adelaide, SA, Australia

[10] Univ Adelaide, South Australian Hlth & Med Res Inst, Adelaide, SA, Australia

[11] Free Univ Amsterdam, Amsterdam Publ Hlth Res Inst, Dept Hlth Sci, Fac Earth & Life Sci, Amsterdam, Netherlands

来源：

ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA | 2018年 / 97卷 / 03期

关键词：

Cost-effectiveness; curettage; incomplete evacuation; miscarriage; misoprostol; EARLY-PREGNANCY FAILURE; MEDICAL-MANAGEMENT; SPONTANEOUS-ABORTION; SURGICAL-MANAGEMENT; MULTIPLE IMPUTATION; ECONOMIC-EVALUATION; MIST TRIAL; RISK; METAANALYSIS; STRATEGIES;

D O I：

10.1111/aogs.13283

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

IntroductionCurettage 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 methodsFrom 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. ResultsWe 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 Euro1157; 95% C confidence interval Euro955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was Euro8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of Euro18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. ConclusionsCurettage 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.

引用

页码：294 / 300

页数：7

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