Cost-effectiveness of curettage vs. expectant management in women with an incomplete evacuation after misoprostol treatment for first-trimester miscarriage: a randomized controlled trial and cohort study

on behalf of the MisoREST study group, Marike Lemmers, Marianne A.C. Verschoor, Patrick M. Bossuyt, Judith A.F. Huirne, Teake Spinder, Theodoor E. Nieboer, Marlies Y. Bongers, Ineke A.H. Janssen, Marcel H.A. Van Hooff, Ben W.J. Mol, Willem M. Ankum, Ben Mol

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown. Material and methods: From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost–utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping. Results: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage vs. 83% of the women after expectant management (mean difference 13%, 95% confidence interval 5–20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95% C confidence interval €955–1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. Conclusions: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.

LanguageEnglish
Pages294-300
Number of pages7
JournalActa obstetricia et gynecologica Scandinavica
Volume97
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Cost-effectiveness
  • curettage
  • incomplete evacuation
  • miscarriage
  • misoprostol

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{ebee4f49dfe348378b5b16ea459ee9e2,
title = "Cost-effectiveness of curettage vs. expectant management in women with an incomplete evacuation after misoprostol treatment for first-trimester miscarriage: a randomized controlled trial and cohort study",
abstract = "Introduction: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown. Material and methods: From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost–utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping. Results: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96{\%} of the women treated with curettage vs. 83{\%} of the women after expectant management (mean difference 13{\%}, 95{\%} confidence interval 5–20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95{\%} C confidence interval €955–1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95{\%}. Conclusions: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.",
keywords = "Cost-effectiveness, curettage, incomplete evacuation, miscarriage, misoprostol",
author = "{on behalf of the MisoREST study group} and Marike Lemmers and Verschoor, {Marianne A.C.} and Bossuyt, {Patrick M.} and Huirne, {Judith A.F.} and Teake Spinder and Nieboer, {Theodoor E.} and Bongers, {Marlies Y.} and Janssen, {Ineke A.H.} and {Van Hooff}, {Marcel H.A.} and Mol, {Ben W.J.} and Ankum, {Willem M.} and Ben Mol",
year = "2018",
month = "3",
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doi = "10.1111/aogs.13283",
language = "English",
volume = "97",
pages = "294--300",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
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TY - JOUR

T1 - Cost-effectiveness of curettage vs. expectant management in women with an incomplete evacuation after misoprostol treatment for first-trimester miscarriage

T2 - Acta Obstetricia et Gynecologica Scandinavica

AU - on behalf of the MisoREST study group

AU - Lemmers, Marike

AU - Verschoor, Marianne A.C.

AU - Bossuyt, Patrick M.

AU - Huirne, Judith A.F.

AU - Spinder, Teake

AU - Nieboer, Theodoor E.

AU - Bongers, Marlies Y.

AU - Janssen, Ineke A.H.

AU - Van Hooff, Marcel H.A.

AU - Mol, Ben W.J.

AU - Ankum, Willem M.

AU - Mol, Ben

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Introduction: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown. Material and methods: From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost–utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping. Results: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage vs. 83% of the women after expectant management (mean difference 13%, 95% confidence interval 5–20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95% C confidence interval €955–1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. Conclusions: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.

AB - Introduction: Curettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first-trimester miscarriage. The cost-effectiveness of curettage vs. expectant management in this group is unknown. Material and methods: From June 2012 until July 2014 we conducted a randomized controlled trial and parallel cohort study in the Netherlands, comparing curettage with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first-trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus 6 weeks after study entry, or an uneventful course. Cost-effectiveness and cost–utility analyses were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated using bootstrapping. Results: We included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage vs. 83% of the women after expectant management (mean difference 13%, 95% confidence interval 5–20). Mean costs were significantly higher in the curettage group (mean difference €1157; 95% C confidence interval €955–1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was €8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of €18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. Conclusions: Curettage is not cost-effective compared with expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.

KW - Cost-effectiveness

KW - curettage

KW - incomplete evacuation

KW - miscarriage

KW - misoprostol

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U2 - 10.1111/aogs.13283

DO - 10.1111/aogs.13283

M3 - Article

VL - 97

SP - 294

EP - 300

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 3

ER -