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

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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. / Lemmers, Marike ; Verschoor, Marianne A. C.; Bossuyt, Patrick M.; Huirne, Judith A. F.; Spinder, Teake; Nieboer, Theodoor E.; Bongers, Marlies Y.; Janssen, Ineke A. H.; van Hooff, Marcel H. A.; Mol, Ben W. J.; Ankum, Willem M.; Bosmans, Judith E.

In: Acta obstetricia et gynecologica Scandinavica, Vol. 97, No. 3, 2018, p. 294-300.

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

BibTeX

@article{2a7106d2c77542f5b2301296c525dbe5,

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 = "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. 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. 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%. 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",

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.}",

year = "2018",

doi = "10.1111/aogs.13283",

language = "English",

volume = "97",

pages = "294--300",

journal = "Acta obstetricia et gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley-Blackwell",

number = "3",

}

RIS

TY - JOUR

T1 - 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

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.

PY - 2018

Y1 - 2018

N2 - 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. 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. 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%. 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 - 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. 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. 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%. 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

U2 - 10.1111/aogs.13283

DO - 10.1111/aogs.13283

M3 - Article

C2 - 29266169

VL - 97

SP - 294

EP - 300

JO - Acta obstetricia et gynecologica Scandinavica

JF - Acta obstetricia et gynecologica Scandinavica

SN - 0001-6349

IS - 3

ER -

ID: 4465132

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