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[Cost effectiveness of methotrexate treatment of ectopic pregnancy]
F Lécuru1, R Taurelle, C Viens-Bitker
1Service de Gynécologie-Obstétrique, Hôpital Boucicaut, Paris.
Objectives:
Compare the cost of managing unruptured extra-uterine pregnancy with methotrexate injections and with conservative laparoscopic surgery.
Methods:
Review of the literature to quantify post-therapeutic follow-up after echoguided methotrexate injections or laparoscopic salpingotomy. The cost of each procedure was determined on the basis of the French National Health Insurance nomenclature (Caisse National d'Assurance-Maladie). Total costs thus induced were then compared.
Results:
The cost of medical treatment for unruptured extra-uterine pregnancy was similar to laparoscopic surgical treatment (10,267 and 11,858 FFr respectively). The duration of hospitalization was short for methotrexate injection but the number of biology examinations required for post-therapeutic follow-up was greater.
Conclusion:
Cost of medical treatment and laparoscopic surgical treatment reported in the literature vary little. Ambulatory methotrexate injections and the major reduction in biology follow-up examinations are required for significant reduction in medical treatment costs. Rigorous patient selection for methotrexate treatment could both improve effectiveness and reduce costs. Eliminating anaesthesia-related mortality as well as any surgery would be the true beneficial effect of medical treatment.