A cost-effectiveness study of changing medical practice in early pregnancy

Until recent years women with symptoms consistent with miscarriage either referred themselves or were referred by their doctors to the local Accident and Emergency (A&E) department. This generally resulted in admission to a gynaecological ward and delayed treatment. This paper examines the costs and benefits of an early pregnancy assessment clinic (EPAC), at a teaching hospital in North East England, to deal with the complications in the first trimester. The data show clear benefits together with cost savings. There is an unambiguous policy recommendation to implement the proposed clinic. The paper examines the delivery of service provision and the impact on referral patterns to the A&E department and raises the issue of care provision at the margin. Finally, the authors show the results of an evaluative survey of the clinic from returns of a questionnaire sent to and completed by local general practitioners.