Direct cost of single dose methotrexate for unruptured ectopic pregnancy. Prospective comparison with laparoscopy

to compare the direct cost of single dose methotrexate (MTX) and laparoscopy in the treatment of unruptured ectopic pregnancy (unruptured EP).

A prospective nonrandomized study. Thirty-two women received intramuscular MTX (1 mg/kg) on an out-patient basis when they fulfilled the following requirements: human chorionic gonadotropin (hCG) level <5000 IU/l, hematosalpinx diameter <3 cm and peritoneal fluid <100 cc. Follow-up consisted of clinical controls and hCG assays. Twenty-seven women eligible for MTX therapy according to the above conditions underwent laparoscopic salpingectomy because some of them refused the therapy while others had contraindications to MTX. We recorded all the medical expenses related to the out-patient and in-patient management for the two treatment options. The cost was calculated according to the French General Nomenclature of Professional Acts and expressed in Euros.

MTX resulted in a significantly lower mean direct cost in comparison with surgery (E 1145 vs. 2442, P=0.006) that was mainly due to shortened hospital stay (1.1 vs. 2.8 days, P=0.007). Conversely MTX required a significantly higher number of medical acts during the follow-up. Costs for MTX therapy were closely related to the length of hospitalization and to the duration of the follow-up.

Single dose MTX provides significant cost-savings when compared to laparoscopy. Savings reach a peak for small unruptured EP because hospitalization is not required and the length of follow-up reduced.