Systemic methotrexate treatment of tubal pregnancy was more costly than laparoscopic salpingostomy
OBJECTIVE To compare the cost of treatment of unruptured tubal pregnancy with systemic methotrexate and laparoscopic salpingostomy. DESIGN Cost-minimization evaluation based on a multicentre, randomized controlled trial. Allocation was blocked and stratified for human chorionic gonadotropin (hCG) level. SETTING Six university hospitals in The Netherlands. SUBJECTS 100 hemodynamically stable women with laparoscopically confirmed, unruptured tubal pregnancies, without fetal heart activity or active bleeding. Mean gestational age was 47 days and median serum hCG was 2075 (range 110-19,500) IU/L. INTERVENTION All women underwent laparoscopy to confirm the tubal pregnancy. 49 women were randomized to undergo laparoscopic salpingostomy immediately, and 51 women to receive systemic methotrexate 1.0 mg/kg i.m., every other day for four doses and folinic acid 0.1 mg/kg orally, on alternate days. Costs were based on actual expenditures, including both direct and indirect costs. MAIN OUTCOME MEASURES Mean cost Cm USS) per patient for treatment with methotrexate or laparoscopic salpingostomy. MAIN RESULTS The mean (range) initial hospital stay was 3.2 (1-12) days in the methotrexate group and 2.5 (2-7) days in the laparoscopy group. Seven women in the methotrexate group and 10 in the laparoscopy group required the alternate treatment. Women in the methotrexate group had more transvaginal sonograms (mean 2.3 vs 1.3), more outpatient visits (mean 8.9 vs 6.9), and more visits to a general practitioner (mean 1.6 vs 1.1). The mean medical cost per patient was S3299 for methotrexate and S2520 for laparoscopy (difference S779, 95% CI S28-2384). Women in the methotrexate group were more likely to require home care and took more days off work (mean 38 vs 28). The mean total cost per patient was S5721 for methotrexate and S4066 for laparoscopy (difference S1655, CI S906-2414). The two treatments had similar total costs in women with an initial hCG level < 1500 IU/L, but methotrexate was much more expensive in women with higher hCG levels. If the laparoscopy were eliminated for the methotrexate group, the medical cost would be S944 less than for laparoscopy, and the total costs would be similar. CONCLUSION Treatment of unruptured tubal pregnancy with systemic methotrexate was more costly than laparoscopic salpingostomy. © 2000 Harcourt Publishers Ltd.
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