Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial.
Cost-effectiveness
cost utility
economic evaluation
management
miscarriage
model
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
accepted:
20
04
2021
pubmed:
11
5
2021
medline:
3
8
2021
entrez:
10
5
2021
Statut:
ppublish
Résumé
To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage. Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS). Twenty-eight UK NHS early pregnancy units. A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage. Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets. Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs). For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a QALYs difference of 0.04% (95% CI -0.01 to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost saving of £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is the current medical management strategy. However, the model-based evidence suggests that the intervention is a less effective but less costly strategy than surgical management. The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage. The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages.
Identifiants
pubmed: 33969614
doi: 10.1111/1471-0528.16737
doi:
Substances chimiques
Abortifacient Agents
0
Misoprostol
0E43V0BB57
Mifepristone
320T6RNW1F
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1534-1545Subventions
Organisme : Health Technology Assessment Programme
ID : 15/160/02
Informations de copyright
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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