An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy.
نویسندگان
چکیده
OBJECTIVE To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy. DESIGN A cost minimisation study undertaken alongside a randomised trial. SETTING Departments of Obstetrics and Gynaecology in three hospitals in Auckland, New Zealand. PARTICIPANTS Sixty-two women with an ectopic pregnancy randomised to treatment with either a single dose of methotrexate (50 mg/m2) or laparoscopic surgery. MAIN OUTCOME MEASURES Direct and indirect costs based on the results of the randomised trial. RESULTS Direct costs per case were significantly lower in the methotrexate group (mean $NZ 1,470) than in the laparoscopy group (mean $NZ 3,083) with a mean difference of $NZ 1,613 (95% CI $NZ 1,166 - $NZ 2,061). These significant differences existed under a wide range of alternative assumptions about unit costs. The difference in direct costs in favour of methotrexate was greatest for women presenting with low pretreatment serum beta-hCG concentrations. Mean indirect costs were also significantly lower in the methotrexate group (mean $NZ 1,141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 - $NZ 1,240). For women presenting with pretreatment serum beta-hCG concentrations of over 1,500 IU/ L this difference in indirect costs is lost due to the prolonged follow up required and a higher rate of surgical intervention in women receiving methotrexate. CONCLUSION This economic evaluation shows that treating suitable women with an ectopic pregnancy using systemic methotrexate therapy results in a significant reduction in direct costs. The indirect costs borne by the woman and her carers are only likely to be reduced in women with pretreatment serum beta-hCG concentrations under 1,500 IU/L.
منابع مشابه
مقایسه اثر درمانی تجویز متوترکسات تک دوز با دو دوز در درمان حاملگی خارج رحمی
Background & Aims: Ectopic pregnancy currently is the leading cause of pregnancy-related death during the first trimester. The methotrexate (MTX) was accepted as medical treatment and reduced surgery in unruptured ectopic pregnancy. Despite numerous studies, the best protocol for MTX treatment remains controversial. The present study compares single and two dose MTX administrations protocol in ...
متن کاملAn economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy
Study population The parent study included women with an unruptured ectopic pregnancy, diagnosed by an algorithm using quantitative serum beta-human chorionic gonadotrophin (hCG) and transvaginal ultrasound, with or without a desire for future fertility. To be were eligible for the trial, the women had to have a serum beta-hCG concentration of less than 5,000 IU/L and an adnexal mass of less th...
متن کاملFertility Outcome after Treatment of Unruptured Ectopic Pregnancy with Two Different Methotrexate Protocols
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Effect of Single-Dose Methotrexate Treatment on Ovarian Reserve in Women with Ectopic Pregnancy Undergoing Infertility Treatment: A Single-Center Experience
Background: The aim of this study was evaluation of the impact of single-dose methotrexate (MTX) treatment on ovarian reserve in women with ectopic pregnancy (EP) undergoing infertility treatment in Iranian population. Materials and Methods: This prospective cohort study was done between March 2015 and March 2017 in Tehran General Women Hospital, Tehran, Iran. We enrolled 20 patients with EP wh...
متن کاملMethotrexate provides significant cost savings for the treatment of unruptured ectopic pregnancy.
The aim of this study was to compare direct and indirect costs of single-dose methotrexate and laparoscopy in the treatment of unruptured ectopic pregnancy. We conducted a prospective study between 1 January 1995 and 31 May 1997 and recorded costs accrued from outpatient and inpatient treatment with methotrexate (group I) and laparoscopy (group II). We used the French National Social Security n...
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ورودعنوان ژورنال:
- BJOG : an international journal of obstetrics and gynaecology
دوره 108 2 شماره
صفحات -
تاریخ انتشار 2001