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

doi:10.1111/aogs.13283

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

Research output: Contribution to Journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	294-300
Number of pages	7
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	97
Issue number	3
Early online date	20 Dec 2017
DOIs	https://doi.org/10.1111/aogs.13283
Publication status	Published - Mar 2018

Funding

This study was funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066. The views expressed in this article are those of the authors and not necessarily those of ZonMW.

Funders	Funder number
Dutch Organization for Health Research and Development
ZonMw	80-82310-97-12066

Keywords

Cost-effectiveness
curettage
incomplete evacuation
miscarriage
misoprostol

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cost-effectiveness of curettage vs. expectant management in women with an incomplete evacuation after misoprostol treatment for first-trimester miscarriageFinal published version, 239 KBLicence: Article 25fa Dutch Copyright Act

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@article{7d22431782fb4915a49f585af991b372,

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 = "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 Bosmans, {Judith E.} and {on behalf of the MisoREST study group}",

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year = "2018",

month = mar,

doi = "10.1111/aogs.13283",

language = "English",

volume = "97",

pages = "294--300",

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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.
In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 97, No. 3, 03.2018, p. 294-300.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

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

T2 - a randomized controlled trial and cohort study

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 - Bosmans, Judith E.

AU - on behalf of the MisoREST study group

PY - 2018/3

Y1 - 2018/3

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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DO - 10.1111/aogs.13283

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JO - Acta Obstetricia et Gynecologica Scandinavica

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ER -

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

Funding

Keywords

UN SDGs

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