Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management

Background: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed. Methods: We performed a cost-minimization analysis alongside a multicentre randomized trial. Clinical data and data on the use of medical resources were obtained from a randomized trial comparing misoprostol and curettage, which had shown that misoprostol reduced the need for curettage in 53%. In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90%. Results: Direct costs per case were significantly lower in the misoprostol group (mean €433) than in the curettage group (mean €683) (mean difference €250, 95% CI 184 to 316, P < 0.001). These significant differences existed under a wide range of alternative assumptions about unit costs. The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol. Mean indirect costs were equal for both groups (misoprostol mean €486; curettage mean €428; mean difference €60, 95% CI -61 to 179, P = 0.51). The mean total costs for a strategy starting with misoprostol was €915 versus €1107 for curettage, with a mean difference between both groups of €192 (95% CI 33 to 351, P = 0.04). An increase of the complete evacuation rates for initial misoprostol therapy to 90% in the sensitivity analysis increased the cost difference between misoprostol and curettage to €550. Conclusion: The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage.