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

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; Judith E. Bosmans; MISOREST Study Grp

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

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, Judith E. Bosmans, MISOREST Study Grp

^*Corresponding author for this work

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

Abstract

IntroductionCurettage 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 methodsFrom 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. ResultsWe 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 Euro1157; 95% C confidence interval Euro955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was Euro8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of Euro18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. ConclusionsCurettage 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
DOIs	https://doi.org/10.1111/aogs.13283
Publication status	Published - 1 Mar 2018

Keywords

Cost-effectiveness
curettage
incomplete evacuation
miscarriage
misoprostol
EARLY-PREGNANCY FAILURE
MEDICAL-MANAGEMENT
SPONTANEOUS-ABORTION
SURGICAL-MANAGEMENT
MULTIPLE IMPUTATION
ECONOMIC-EVALUATION
MIST TRIAL
RISK
METAANALYSIS
STRATEGIES

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10.1111/aogs.13283

Cite this

Lemmers, M., Verschoor, M. A. C., Bossuyt, P. M., Huirne, J. A. F., Spinder, T., Nieboer, T. E., Bongers, M. Y., Janssen, I. A. H., Van Hooff, M. H. A., Mol, B. W. J., Ankum, W. M., Bosmans, J. E., & MISOREST Study Grp (2018). 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. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 294-300. https://doi.org/10.1111/aogs.13283

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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 = "IntroductionCurettage 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 methodsFrom 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. ResultsWe 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 Euro1157; 95% C confidence interval Euro955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was Euro8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of Euro18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. ConclusionsCurettage 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, EARLY-PREGNANCY FAILURE, MEDICAL-MANAGEMENT, SPONTANEOUS-ABORTION, SURGICAL-MANAGEMENT, MULTIPLE IMPUTATION, ECONOMIC-EVALUATION, MIST TRIAL, RISK, METAANALYSIS, STRATEGIES",

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 {MISOREST Study Grp}",

year = "2018",

month = mar,

day = "1",

doi = "10.1111/aogs.13283",

language = "English",

volume = "97",

pages = "294--300",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley",

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Lemmers, M, Verschoor, MAC, Bossuyt, PM, Huirne, JAF, Spinder, T, Nieboer, TE, Bongers, MY, Janssen, IAH, Van Hooff, MHA, Mol, BWJ, Ankum, WM, Bosmans, JE & MISOREST Study Grp 2018, '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', Acta Obstetricia et Gynecologica Scandinavica, vol. 97, no. 3, pp. 294-300. https://doi.org/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. / Lemmers, Marike; Verschoor, Marianne A. C.; Bossuyt, Patrick M. et al.
In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 97, No. 3, 01.03.2018, 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 - MISOREST Study Grp

PY - 2018/3/1

Y1 - 2018/3/1

N2 - IntroductionCurettage 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 methodsFrom 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. ResultsWe 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 Euro1157; 95% C confidence interval Euro955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was Euro8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of Euro18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. ConclusionsCurettage 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 - IntroductionCurettage 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 methodsFrom 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. ResultsWe 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 Euro1157; 95% C confidence interval Euro955-1388). The incremental cost-effectiveness ratio for curettage vs. expectant management was Euro8586 per successfully treated woman. The cost-effectiveness acceptability curve showed that at a willingness-to-pay of Euro18 200/extra successfully treated women, the probability that curettage is cost-effective is 95%. ConclusionsCurettage 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

KW - EARLY-PREGNANCY FAILURE

KW - MEDICAL-MANAGEMENT

KW - SPONTANEOUS-ABORTION

KW - SURGICAL-MANAGEMENT

KW - MULTIPLE IMPUTATION

KW - ECONOMIC-EVALUATION

KW - MIST TRIAL

KW - RISK

KW - METAANALYSIS

KW - STRATEGIES

U2 - 10.1111/aogs.13283

DO - 10.1111/aogs.13283

M3 - Article

C2 - 29266169

SN - 0001-6349

VL - 97

SP - 294

EP - 300

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 3

ER -

Lemmers M, Verschoor MAC, Bossuyt PM, Huirne JAF, Spinder T, Nieboer TE et al. 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. Acta Obstetricia et Gynecologica Scandinavica. 2018 Mar 1;97(3):294-300. doi: 10.1111/aogs.13283