Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis
[EN]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 st...
| Autores: | , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2019 |
| País: | España |
| Institución: | Universidad de Salamanca (USAL) |
| Repositorio: | GREDOS. Repositorio Institucional de la Universidad de Salamanca |
| OAI Identifier: | oai:gredos.usal.es:10366/154814 |
| Acceso en línea: | http://hdl.handle.net/10366/154814 |
| Access Level: | acceso abierto |
| Palabra clave: | Abortion Miscarriage Medical treatment of abortion Misoprostol Dilation and curettage misoprostol |
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Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysisCubo Nava, Ana MaríaSoto Pino, Zandra MilenyHaro Pérez, Ana MaríaHernández-Hernández, EstrellaDoyagüe Sánchez, María JoséSayagués Manzano, José MaríaAbortionMiscarriageMedical treatment of abortionMisoprostolDilation and curettageMisoprostolmisoprostol[EN]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.Public Library of Science202420242019info:eu-repo/semantics/articlehttp://hdl.handle.net/10366/154814reponame:GREDOS. Repositorio Institucional de la Universidad de Salamancainstname:Universidad de Salamanca (USAL)Inglésinfo:eu-repo/semantics/openAccessoai:gredos.usal.es:10366/1548142026-06-07T06:28:51Z |
| dc.title.none.fl_str_mv |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| title |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| spellingShingle |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis Cubo Nava, Ana María Abortion Miscarriage Medical treatment of abortion Misoprostol Dilation and curettage Misoprostol misoprostol |
| title_short |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| title_full |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| title_fullStr |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| title_full_unstemmed |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| title_sort |
Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis |
| dc.creator.none.fl_str_mv |
Cubo Nava, Ana María Soto Pino, Zandra Mileny Haro Pérez, Ana María Hernández-Hernández, Estrella Doyagüe Sánchez, María José Sayagués Manzano, José María |
| author |
Cubo Nava, Ana María |
| author_facet |
Cubo Nava, Ana María Soto Pino, Zandra Mileny Haro Pérez, Ana María Hernández-Hernández, Estrella Doyagüe Sánchez, María José Sayagués Manzano, José María |
| author_role |
author |
| author2 |
Soto Pino, Zandra Mileny Haro Pérez, Ana María Hernández-Hernández, Estrella Doyagüe Sánchez, María José Sayagués Manzano, José María |
| author2_role |
author author author author author |
| dc.subject.none.fl_str_mv |
Abortion Miscarriage Medical treatment of abortion Misoprostol Dilation and curettage Misoprostol misoprostol |
| topic |
Abortion Miscarriage Medical treatment of abortion Misoprostol Dilation and curettage Misoprostol misoprostol |
| description |
[EN]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. |
| publishDate |
2019 |
| dc.date.none.fl_str_mv |
2019 2024 2024 |
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info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
http://hdl.handle.net/10366/154814 |
| url |
http://hdl.handle.net/10366/154814 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.rights.none.fl_str_mv |
info:eu-repo/semantics/openAccess |
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openAccess |
| dc.publisher.none.fl_str_mv |
Public Library of Science |
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Public Library of Science |
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reponame:GREDOS. Repositorio Institucional de la Universidad de Salamanca instname:Universidad de Salamanca (USAL) |
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Universidad de Salamanca (USAL) |
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GREDOS. Repositorio Institucional de la Universidad de Salamanca |
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GREDOS. Repositorio Institucional de la Universidad de Salamanca |
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15,301603 |