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Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice
M Niinimäki1, P Karinen, A-L Hartikainen
1Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland. maarit.niinimaki@oulu.fi
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 euro1688 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.
