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Treating miscarriages: a randomised study of cost‐effectiveness in medical or surgical choice
Author(s) -
Niinimäki M,
Karinen P,
Hartikainen AL,
Pouta A
Publication year - 2009
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2009.02161.x
Subject(s) - medicine , miscarriage , patient satisfaction , recurrent miscarriage , randomized controlled trial , obstetrics and gynaecology , cost effectiveness , physical therapy , surgery , pregnancy , genetics , biology , risk analysis (engineering)
Objective The aim was to carry out a cost effectiveness analysis (CEA) of medical and surgical treatment of miscarriage using quantitative and qualitative indicators. Design A prospective study where the data of the clinical course of the treatment and the patients` experiences (pain and satisfaction) were collected from a previous randomised study. Setting Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland. Population Ninety‐eight eligible women with a diagnosed miscarriage. Methods The incremental cost‐effectiveness ratio (ICER) was calculated by using institutional prices (provider’s aspect) of the medical care and the number of patients who experienced pain, dissatisfaction or unsuccessful treatment while treated for the miscarriage. Main outcome measures Primary (uncomplicated treatment) and secondary (complications and other unplanned events) costs of the treatments. Results Primary costs of the surgical treatment were higher, but the more frequent unplanned events and complications in the medical group brought the costs to the same level. In the medical group, based on the ICER, 12 patients more experienced pain, 7 patients more were dissatisfied with the treatment and 5 patients more had unsuccessful treatment compared with surgically treated patients. In theory, these negative outcomes could have been avoided by investing €1688 more in the surgical treatment. Conclusions Medical treatment of miscarriage was not more cost‐effective, when the adverse events were considered. As neither of these two methods was economically superior, the treatment choice should be made on an individual basis by respecting the patient’s choice.