The Potential Impact of Introducing Pregnancy Testing into Menstrual Regulation Services in Vietnam

Abstract

Pregnancy testing is not a routine component of menstrual regulation services in Viet Nam and an estimated 25% of women who undergo this procedure are not pregnant. The potential cost-effectiveness of pregnancy testing in advance of menstrual regulation was investigated in a study of 923 consecutive women seeking this service during a 10-month period in 1996-97 at a government clinic in rural Thai Binh Province. Administration of up to three pregnancy tests revealed that 164 of these women (18%) were not in fact pregnant. The initial Quickstick test accurately identified 738 of the 759 pregnant women (97% sensitivity) and 157 of the 164 nonpregnant women (96% specificity). 90% of pregnant women compared with 26% of nonpregnant women exhibited two or more clinical signs of pregnancy at presentation for menstrual regulation. An estimated 800000 menstrual regulations are performed in Viet Nam each year at a cost of about US$2.75/procedure to the Vietnamese government. By providing pregnancy tests for all women seeking menstrual regulation (at a total cost of $720000) the government would avoid spending $380000 for unnecessary procedures for a net testing cost of $340000. Assuming costs of more than $12 per menstrual regulation for women with complications and $8.50 for those with none the avoidance of unnecessary procedures would save Vietnamese women an estimated total of $1.2 million and reduce health risks and pain. 97% of women enrolled in this study supported routine pregnancy testing. A less expensive alternative strategy would entail pregnancy testing only of women who have no symptoms or clinical signs of pregnancy at presentation for menstrual regulation.