Intravaginal misoprostol versus uterine curettage for missed abortion: A cost‐effectiveness analysis

• Published in: The journal of obstetrics and gynaecology research Vol. 48; no. 5; pp. 1110 - 1115
• Main Authors: Torres‐Miranda, María Dolores, Duro Gómez, Jorge, Peña Lobo‐Gonçalves, Sonja, De la Torre González, Antonio Jesús, Castelo‐Branco, Camil
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.05.2022; Wiley Subscription Services, Inc
• Subjects: Abortifacient Agents, Nonsteroidal - therapeutic use; Abortion; Abortion, Induced; Abortion, Missed - drug therapy; Abortion, Missed - surgery; Administration, Intravaginal; Cost-Benefit Analysis; Curettage; effectiveness; Female; Humans; Medical treatment; Misoprostol; Misoprostol - therapeutic use; missed abortion; Patients; Pregnancy; Prospective Studies; satisfaction; Side effects; Uterus; effectiveness; curettage; missed abortion; satisfaction; misoprostol
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.15201

Purpose To evaluate the cost‐effectiveness of a strategy based on direct‐acting uterine curettage (UC) versus a pre‐direct‐acting misoprostol (1600 mg) in patients with missed abortion (MA), from the perspective of a National Health System. Methods An open prospective cohort study was carried out at Reina Sofía University Hospital (Córdoba, Spain) from January 1, 2019 to December 31, 2019 in 180 patients diagnosed with MA. The patients chose medical treatment with intravaginal misoprostol (800 μg/4 h) or UC after receiving complete and detailed information. The effectiveness, clinical characteristics of the patients, costs of treating and managing the disease, and satisfaction with the procedures were recorded. Results One hundred and forty‐five patients (80.6%) chose misoprostol versus 35 patients (19.4%) who chose UC. The effectiveness of misoprostol has been 42% evaluated at 48 h; UC success rate has been 100%. The incidence of side effects is significantly higher in patients treated with misoprostol (p < 0.05); as well as the number of care received by the patient (p < 0.05). Satisfaction is higher in patients treated with UC (p < 0.05). However, the cost is almost 5‐folds higher in patients treated with UC (p < 0.05). Conclusion UC has a higher success rate, greater satisfaction, and a lower incidence of side effects, although significantly increases the cost compared to misoprostol in MA.