Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso Trial.

Okeke Ogwulu, C B, Williams, E V, Chu, J J, Devall, A J, Beeson, L E, Hardy, P, Cheed, V, Yongzhong, S, Jones, L L, La Fontaine Papadopoulos, J H, Bender-Atik, R, Brewin, J, Hinshaw, K, Choudhary, M, Ahmed, A, Naftalin, J, Nunes, N, Oliver, A, Izzat, F, Bhatia, K, Hassan, I, Jeve, Y, Hamilton, J, Deb, S, Bottomley, C, Ross, J, Watkins, L, Underwood, M, Cheong, Y, Kumar, C S, Gupta, P, Small, Rachel, Pringle, S, Hodge, F S, Shahid, A, Horne, A W, Quenby, S, Gallos, I D, Coomarasamy, A and Roberts, T E (2021) Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso Trial. BJOG : an international journal of obstetrics and gynaecology. ISSN 1471-0528. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

OBJECTIVE

To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage.

DESIGN

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 non-parametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the NHS perspective.

SETTING

28 UK NHS early pregnancy units.

PARTICIPANTS

711 women aged 16-39 years with ultrasound evidence of a missed miscarriage.

INTERVENTIONS

Mifepristone and misoprostol or matched placebo and misoprostol tablets.

MAIN OUTCOME MEASURES

Cost per additional successfully managed miscarriage and QALYs.

RESULTS

For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI: 0.7% to 12.5%) per successfully managed miscarriage and 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 to £338). Hence, MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that MifeMiso intervention is dominant compared to expectant management and 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.

CONCLUSIONS

The within-trial analysis found that based on cost-effectiveness grounds, MifeMiso intervention is likely to be recommended by decision-makers for the medical management of women presenting with a missed miscarriage.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: W Public health. Health statistics. Occupational health. Health education
WP Gynaecology. Women’s health
Divisions: Womens and Childrens > Gynaecology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 17 May 2021 14:28
Last Modified: 17 May 2021 14:28
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4328

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