Authors:
Sowter MC. Farquhar CM. Gudex G.
Institution:
Dr. M.C. Sowter, Fertility Associates Ltd., Ascot Integrated Hospital, Private Bag 28910, Auckland; New Zealand.
Title:
An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy (2001-3337).
Source:
British Journal of Obstetrics and Gynaecology. Vol 108(2) (pp04-212), 2001.
Abstract:
Objectives:
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 (50mg/m2) or laparoscopic surgery.
Settings, Design and 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 1470) than in the laparoscopy group (mean $NZ 3083) with a mean difference of $NZ 1613 (95% CI $NZ 1166 - $NZ 2061). 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 1141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 - $NZ 1240). For women presenting with pretreatment serum beta-hCG concentrations of over 1500 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 1500 IU/L.
Please click on the required question.
- 1 What is a miscarriage?
- 2 What are the different types of miscarriage?
- 3 How accurate are pregnancy tests?
- 4 What is a blighted ovum?
- 5 I have had a hydatidiform mole. What is this?
- 6 Why did I have a spontaneous miscarriage?
- 7 How frequently do miscarriages occur?
- 8 I am miscarrying. How should this be treated?
- 8a Can miscarriage result in anxiety and depression?
- 9 What is meant by recurrent miscarriage?
- 10 I have a problem with recurrent miscarriage. What is the chance of my next pregnancy being successful?
- Q 12.11 Recurrent Miscarriage I have miscarried again. Why does this keep happening?
- 12 What congenital problems might be associated with recurrent miscarriage and how could they be treated?
- 13 What traumatic conditions can cause recurrent miscarriage and how can they be treated?
- 14 Can infection cause recurrent miscarriage and would treatment help?
- 15 Could a metabolic disorder cause recurrent miscarriage?
- 16 Could a hormonal problem account for recurrent miscarriage and would hormone treatment help me?
- 17 Could an autoimmune problem cause recurrent miscarriage and how could this be treated?
- 18 Could a tumour cause recurrent miscarriage?
- 19 What degenerative processes may be associated with recurrent miscarriage?
- 20 After every miscarriage I become more depressed. Could this account for the problem?
- 21 Is it always possible to explain recurrent miscarriage?
- 22 I have a problem with recurrent miscarriage. What treatment is available to ensure that this does not happen again?
- 23 What is an ectopic pregnancy?
- 24 How frequently do ectopic pregnancies occur?
- 25 Why do ectopic pregnancies occur?
- 26 How can an ectopic pregnancy be diagnosed?
- 27 How can an ectopic pregnancy be treated?
- 28 Where can I obtain more information?
- 29 Support Groups.
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