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Economic evaluation of alternative management methods of first-trimester miscarriage based on results from the MIST trial
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Petrou, Stavros, Trinder, J., Brocklehurst, P. and Smith, L. (2006) Economic evaluation of alternative management methods of first-trimester miscarriage based on results from the MIST trial. BJOG: An International Journal of Obstetrics and Gynaecology, 113 (8). pp. 879-889. doi:10.1111/j.1471-0528.2006.00998.x ISSN 1470-0328.
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Official URL: http://dx.doi.org/10.1111/j.1471-0528.2006.00998.x
Abstract
Objectives To compare the cost-effectiveness of alternative management methods of first-trimester miscarriage.
Design Economic evaluation conducted alongside a large randomised controlled trial (the MIST trial).
Setting Early pregnancy assessment units of seven participating hospitals in southern England.
Sample A total of 1200 women with a confirmed pregnancy of less than 13 weeks of gestation with a diagnosis of incomplete miscarriage or missed miscarriage.
Methods Random allocation to expectant management, medical management or surgical management. Collection of health service and broader resource use data, unit costs for each resource item and clinical outcomes.
Main outcome measures Costs (£, 2001–02 prices) to the health service, social services, women, carers and wider society during the first 8 weeks postrandomisation. Cost-effectiveness estimates, expressed in terms of incremental cost per gynaecological infection prevented; cost-effectiveness acceptability curves presented at alternative willingness-to-pay thresholds for preventing gynaecological infection.
Results There was no significant difference in the incidence of gynaecological infection between groups. The net societal cost per woman was estimated at £1086.20 in the expectant group, £1410.40 in the medical group and £1585.30 in the surgical group. Expectant management had a 97.8% probability of being the most cost-effective management method at a willingness-to-pay threshold of £10,000 for preventing one gynaecological infection, while medical management had a 2.2% probability of being the most cost-effective management method. Expectant management retained the highest probability of being the most cost-effective management method at all willingness-to-pay thresholds of less than £70,000 for preventing one gynaecological infection.
Conclusions Expectant and medical management of first-trimester miscarriage possess significant economic advantages over traditional surgical management.
| Item Type: | Journal Article | ||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | BJOG: An International Journal of Obstetrics and Gynaecology | ||||
| Publisher: | Blackwell Publishing | ||||
| ISSN: | 1470-0328 | ||||
| Official Date: | 2006 | ||||
| Dates: |
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| Volume: | 113 | ||||
| Number: | 8 | ||||
| Page Range: | pp. 879-889 | ||||
| DOI: | 10.1111/j.1471-0528.2006.00998.x | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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