Economic evaluation of medical versus surgical strategies for first trimester therapeutic abortion

Abstract

Pregnancy termination and abortion-related complications are well-established problems among women at reproductive age and resulted in significant morbidity and mortality. Accordingly, a systematic study was performed to investigate the economic evaluation studies results on costs and benefits of medical and surgical abortion methods. PubMed, Web of Science, Scopus, Embase, Cochrane library, ProQuest, and ScienceDirect databases as well as Google scholar were searched through June 2021. Original full-text English language studies that performed an economic evaluation analysis comparing medical and surgical methods of pregnancy termination were included in this review. A critical quality assessment was conducted utilizing the Consolidated Health Economic Evaluation Standards checklist. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2020 $US). Overall, 538 records were retrieved, and 20 studies were deemed eligible for qualitative synthesis. Among the reviewed studies, three studies investigated cost-minimization analysis, three studies investigated cost-utility analysis, and 14 studies investigated cost-effectiveness analysis. The directly comparison of medical with surgical abortion was most frequently studied. Medical abortion saved US$ 6 to US$ 2373 per patient's costs. Medical abortion was cost-effective and cost-saving option in compare to the surgical abortion across all perspectives (the incremental cost effectiveness ratio ranged from US$ 419 to US$ 4,044). Quality scores of included studies ranged from 54% to 100%, and 70% of studies received a score of above 85% and had “excellent” quality. According to the results, based on various economic and clinical effectiveness decision-making criteria used in different studies of health economic evaluation, the majority of research provided evidence on the advantage of pharmaceutical methods compared to surgical methods, as well as the advantages of using combinations therapy compared to single therapeutic interventions.

Effects of medical abortion assisted by traditional Chinese medicine: A network meta‐analysis of randomized controlled trials

“…A global economic evaluation of strategies for terminating early pregnancies suggests that medical approaches are more cost-effective than surgical options. 39 A study in China also found that the cost of surgical abortion is significantly higher than medical abortion. 5 With limited healthcare resources in developing countries, determining cost-effective methods for women who need to terminate pregnancies is a vital clinical and public health issue.…”

“…This study aims to identify methods for improving the outcome of medical abortion, which not only is an improvement in the method, but also considers the financial implications that pregnant women have to take into account when undergoing the abortion procedure. A global economic evaluation of strategies for terminating early pregnancies suggests that medical approaches are more cost‐effective than surgical options 39 . A study in China also found that the cost of surgical abortion is significantly higher than medical abortion 5 .…”