Abstract
ObjectivesThe aim of the study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran. MethodsThis study was an economic evaluation that analyzed and compared the cost-effectiveness and cost utility of 3 treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective, and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. ResultsThe incremental cost-effectiveness ratio of surgery compared with single-dose methotrexate was positive and equal to $5812 purchasing power parity; moreover, the results of one-way analysis showed the highest sensitivity toward the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with a single-dose and double-dose methotrexate, respectively and was below the threshold. It was identified as a more cost-effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost-effective treatment for thresholds less than $20 950 purchasing power parity. ConclusionsOn the basis of the results of this study, surgery can be used as the first line of treatment for ectopic pregnancy. In addition, the best drug strategy was single-dose methotrexate because this strategy reduced costs and increased treatment success and quality-adjusted life-years compared with double-dose methotrexate.
Highlights
Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients
Based on the results of the present study, it is recommended that surgery can be used as the first line of treatment for ectopic
Direct medical costs accounted for 64%, 60%, and 74% of the total costs; non-medical direct costs accounted for 16%, 20%, and 7% of the total costs; and indirect costs accounted for 20%, 20%, and 19% of the total costs for patients with single-dose methotrexate, double-dose methotrexate and surgical intervention, respectively
Summary
Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients. The rate of maternal mortality in the country in 2012 and 2013 was 19.9% and 19.8%, respectively, per thousand live births, and ectopic pregnancy was one of the causes of mortality[1] The incidence of this disease has increased significantly in the last century, but the rate is currently relatively stable. Laparoscopy or laparotomies are two common methods utilized for the treatment of an ectopic pregnancy. Except for women with hemodynamically unstable condition, laparoscopy is the preferred surgical method for the treatment of ectopic pregnancy. In this procedure, intramuscular methotrexate is administered when there is concern about probability of remnant trophoblastic cells in the tube or in the peritoneal cavity. A singledose of methotrexate is administered for these patients after laparoscopic surgery[6]
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