Abstract
Objectives: to compare the direct cost of single dose methotrexate (MTX) and laparoscopy in the
treatment of unruptured ectopic pregnancy (unruptured EP). Study design: A prospective nonrandomized study. Thirty-two women received intramuscular MTX (1
mg/kg) on an out-patient basis when they fulfilled the following requirements: human
chorionic gonadotropin (hCG) level <5000 IU/l, hematosalpinx diameter <3 cm and peritoneal
fluid <100 cc. Follow-up consisted of clinical controls and hCG assays. Twenty-seven
women eligible for MTX therapy according to the above conditions underwent laparoscopic
salpingectomy because some of them refused the therapy while others had contraindications
to MTX. We recorded all the medical expenses related to the out-patient and in-patient
management for the two treatment options. The cost was calculated according to the
French General Nomenclature of Professional Acts and expressed in Euros. Results: MTX resulted in a significantly lower mean direct cost in comparison with surgery
(E 1145 vs. 2442, P=0.006) that was mainly due to shortened hospital stay (1.1 vs. 2.8 days, P=0.007). Conversely MTX required a significantly higher number of medical acts during
the follow-up. Costs for MTX therapy were closely related to the length of hospitalization
and to the duration of the follow-up. Conclusion: Single dose MTX provides significant cost-savings when compared to laparoscopy. Savings
reach a peak for small unruptured EP because hospitalization is not required and the
length of follow-up reduced.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Maternal mortality surveillance, United States, 1979–1986.MMWR CDC Surveill Summ. 1991; 40: 1-13
- Incidence of ectopic pregnancy. First results of a population-based register in France.Hum Reprod. 1994; 9: 742-745
- Ectopic pregnancy in the United States: Economic consequences and payment source trends.Obstet Gynecol. 1993; 81: 287-292
- Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case.Fertil Steril. 1982; 37: 851-852
- Intra-amniotic methotrexate versus CO2 laser laparoscopic salpingotomy in the management of tubal ectopic pregnancy — a prospective randomized trial.Fertil Steril. 1994; 62: 876-878
- Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy.Fertil Steril. 1995; 63: 25-29
Hajenius PJ, Engelsbel S, Mol BW et al. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet 1997;Sep 13, 350(9080):774–9.
- Outpatient chemotherapy of unruptured ectopic pregnancy.Fertil Steril. 1989; 51: 435-438
- Efficacy and safety of single dose systemic methotrexate in the treatment of ectopic pregnancy.Fertil Steril. 1994; 62: 716-721
- Single injection of methotrexate for treatment of ectopic pregnancies.Am J Obstet Gynecol. 1994; 171: 1584-1587
- Cost of ectopic pregnancy management: surgery versus methotrexate.Fertil Steril. 1993; 60: 963-969
- Treatment of the small unruptured ectopic pregnancy: a cost analysis of methotrexate versus laparoscopy.Obstet Gynecol. 1996; 88: 123-127
- Cost of unruptured ectopic pregnancy treatment: comparison of laparoscopy and methotrexate injection.Gynaecol Endosc. 1996; 5: 25-28
- A comparison of methotrexate versus laparoscopic surgery for the treatment of ectopic pregnancy: a cost analysis.Hum Reprod. 1996; 11: 2762-2766
- Current status of surgical and nonsurgical management of ectopic pregnancy.Fertil Steril. 1997; 67: 421-423
- Clinical and financial analysis of ectopic pregnancy management at large health plan.J Am Assoc Gynecol Laparosc. 1997; 4: 207-213
- Single dose methotrexate: An expanded clinical trial.Am J Obstet Gynecol. 1993; 168: 1759-1765
- Visualization of free peritoneal fluid with transvaginal sonography. A preliminary study.J Reprod Med. 1991; 36: 729-730
General Nomenclature of Professional Acts, Union des Caisses Nationales de Sécurité Sociale, Paris.
- Reproductive outcome after conservative surgery for unruptured ectopic pregnancy. A 15 years experience.Fertil Steril. 1990; 53: 227-231
- Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients.Fertil Steril. 1991; 56: 453-460
- Operative management of ectopic pregnancy: a cost analysis.Am J Obstet Gynecol. 1996; 175: 90-96
- Single dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience.Am J Obstet Gynecol. 1996; 174: 1840-1848
- The use of a pretherapeutic, predictive score to determine inclusion criteria for the non-surgical treatment of ectopic pregnancy.Hum Reprod. 1991; 6: 995-998
- Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy.Hum Reprod. 1995; 10: 2719-2722
- Is conservative surgery for tubal pregnancy preferable to salpingectomy? An economic analysis.J Obstet Gynaecol. 1997; 104: 834-839
- Complications of gynecologic laparoscopic surgery.Curr Opin Obstet Gynecol. 1995; 7: 257-261
- Complications of laparoscopy — operative and diagnostic.Fertil Steril. 1996; 66: 30-35
- Methotrexate provides significant cost-savings for the treatment of ectopic pregnancy.Clin Drug Invest. 1998; 15: 405-411
- Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility.Hum Reprod. 1998; 13: 3239-3243
Article Info
Publication History
Accepted:
April 21,
1999
Received:
January 16,
1999
Identification
Copyright
© 2000 Elsevier Science Ireland Ltd. Published by Elsevier Inc. All rights reserved.
