Cost-Effectiveness of Single-Dose Methotrexate Compared With Laparoscopic Treatment of Ectopic Pregnancy

Abstract Background: Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients. Today, Surgery and pharmaceutical treatments are the common methods of treating the disease. The aim of this study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran.Methods: This study was an economic evaluation which analysed and compared the cost-effectiveness and cost-utility of three treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. The analysis of the collected data was performed using Excel and TreeAge software.Results: The incremental cost-effectiveness ratio of the surgery versus single-dose methotrexate was positive and equal to $5812 PPP; since it was less than the threshold, surgery was considered as a cost-effective method. The incremental cost-utility ratio also identified surgery as the best option. Moreover, the results of one-way showed the highest sensitivity to the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with a single dose and double-dose methotrexate, respectively and below the threshold. It was identified as a more cost-effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost-effective treatment for thresholds less than 21011 PPP dollars.Conclusions: Based on the results of the present study, it is recommended that surgery can be used as the first line of treatment for ectopic. Also, the best drug strategy was single-dose methotrexate. Since these strategies reduce costs and increase treatment success and QALYs compared to double-dose methotrexate.

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Cost-effectiveness analysis of different methods of treatment of tubal ectopic pregnancy in the south of Iran

10.21203/rs.3.rs-25488/v1 ◽

2020 ◽

Author(s):

Bahia Namavar Jahromi ◽

Elahe esmaili ◽

Mozhgan Fardid ◽

Jafari Abdosaleh ◽

Zahra Kavosi ◽

...

Keyword(s):

Single Dose ◽

Cost Effectiveness ◽

Incremental Cost ◽

Ectopic Pregnancy ◽

Cost Effective ◽

Cost Utility ◽

Double Dose ◽

Tubal Ectopic Pregnancy ◽

Dose Methotrexate ◽

The Cost

Abstract Background: Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients. Today, Surgery and pharmaceutical treatments are the common methods of treating the disease. The aim of this study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran.Methods: This study was an economic evaluation which analysed and compared the cost-effectiveness and cost-utility of three treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. The analysis of the collected data was performed using Excel and TreeAge software.Results: The incremental cost-effectiveness ratio of the surgery versus single-dose methotrexate was positive and equal to $5812 PPP; since it was less than threshold, surgery was considered as a cost-effective method. The incremental cost-utility ratio also identified surgery as the best option. Moreover, the results of one-way showed the highest sensitivity to the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with single dose and double-dose methotrexate, respectively and below the threshold. It was identified as the more cost effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost effective treatment for thresholds less than 21011 PPP dollars.Conclusions: Based on the results of the present study, it is recommended that surgery can be used as the first line of treatment for ectopic. Also, the best drug strategy was single dose methotrexate. Since these strategies reduce costs and increase treatment success and QALYs compared to double-dose methotrexate.

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Evaluation of the relationship between endometrial thickness and failure of single-dose methotrexate in ectopic pregnancy

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-005-0009-y ◽

2005 ◽

Vol 272 (4) ◽

pp. 269-272 ◽

Cited By ~ 5

Author(s):

Peter Takacs ◽

Nahida Chakhtoura ◽

Timothy De Santis ◽

Usha Verma

Keyword(s):

Single Dose ◽

Ectopic Pregnancy ◽

Endometrial Thickness ◽

Dose Methotrexate ◽

The Relationship

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Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy

Obstetrics and Gynecology International ◽

10.1155/2015/902426 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Feras Sendy ◽

Eman AlShehri ◽

Amani AlAjmi ◽

Elham Bamanie ◽

Surekha Appani ◽

...

Keyword(s):

Single Dose ◽

Ectopic Pregnancy ◽

Failure Rate ◽

Chart Review ◽

Retrospective Chart Review ◽

Treatment Modalities ◽

Pregnancy Failure ◽

Dose Methotrexate ◽

Mass Size ◽

Primary Management

Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure.Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate.Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound.Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.

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Single-dose methotrexate for the treatment of ectopic pregnancy: Our experience from 2010 to 2015

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.331.11238 ◽

2017 ◽

Vol 33 (1) ◽

Cited By ~ 3

Author(s):

Emre Erdem Taş ◽

Gülin Feykan Feykan Yeğin Akçay ◽

Ayse Filiz Avsar

Keyword(s):

Single Dose ◽

Ectopic Pregnancy ◽

Dose Methotrexate

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Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2011.08.009 ◽

2011 ◽

Vol 116 (1) ◽

pp. 67-71 ◽

Cited By ~ 21

Author(s):

Hossam O. Hamed ◽

Salah R. Ahmed ◽

Abdullah A. Alghasham

Keyword(s):

Single Dose ◽

Ectopic Pregnancy ◽

Dose Methotrexate

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The Importance of Gestational Sac Size of Ectopic Pregnancy in Response to Single-Dose Methotrexate

ISRN Obstetrics and Gynecology ◽

10.1155/2013/269425 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Parichehr Kimiaei ◽

Zahra Khani ◽

Azadeh Marefian ◽

Maryam Gholampour Ghavamabadi ◽

Maryam Salimnejad

Keyword(s):

Single Dose ◽

Confidence Interval ◽

Ectopic Pregnancy ◽

Baseline Level ◽

Surgical Intervention ◽

Dose Methotrexate ◽

Causal Pathway ◽

Gestational Sac ◽

Logistic Regressions ◽

Predictor Factors

This retrospective cohort study was designed in a selective group of 185 patients diagnosed with and treated for ectopic pregnancy. Intramuscular administration of a single dose of methotrexate (50 mg/m2) was performed to measure predictors of failure or resistance to treatment necessitating surgical intervention. During the time of treatment with a single dose of MTX, 20 patients (10.8%) failed to response, in which 6 of 20 (30%) indicated side effects to MTX and rupture of the ectopic pregnancy. Remaining cases () showed resistance to the drug; the level of β-hCG did not fall at least 15% during 7 days after treatment and necessitated laparotomy. In backward-step analysis by multiple logistic regressions of various types of predictor factors, size of gestational sac (coefficient = 1.91, OR = 6.78, 95% confidence interval = 3.18–8.22) and baseline level β-hCG (coefficient = 1.60, OR = 5.0, 95% confidence interval = 4.26–6.72) had significant correlation with leading EP patients failing to response to MTX. This study suggests that further investigation for finding relative contraindications of MTX treatment in EP women should be considered on the gestational sac size because other variables are in the causal pathway of this variable.

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