Mifepristone plus misoprostol less costly than misoprostol alone
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Mifepristone plus misoprostol less costly than misoprostol alone Mifepristone in combination with misoprostol appears to be less costly in the management of miscarriage than misoprostol monotherapy, according to findings of a study published in Obstetrics and Gynecology. Decision-tree analyses populated with data from a randomised controlled trial were used to evaluate the costs of treatrment with mifepristone plus misoprostol versus misoprostol alone, in a US military population. Assumed costs included $91.63* per tablet of mifepristone, $2.95–$3.12 per tablet of misoprostol, and $110–$209.75 per outpatient gynaecology visit. Monte Carlo simulations were used in scenario analyses. Combination therapy was estimated to reduce total costs by 6.3%–19.5% compared with monotherapy. In patients on the federal minimum wage, costs savings per patient were greatest when misoprostol was administered after mifepristone and both in-office manual vacuum aspiration and in-operating room dilation and curettage were available ($190.20), and when dilation and curettage was the only method of uterine evacuation ($217.85). Differences in cost between combination therapy and monotherapy were greater in patients on enlisted wages ($231.82 and $230.33, respectively) and greatest in patients on officer wages ($324.13 and $258.45, respectively). "The results from this analysis, the higher rates of effectiveness reported in randomized controlled studies over the past 3 years, and the endorsement by the American College of Obstetricians and Gynecologists make a strong case for mifepristone followed by misoprostol to become the standard, first-line treatment regimen for the medical management of miscarriage," concluded the authors. * 2019 US dollars Berkley HH, et al. Mifepristone Combination Therapy Compared With Misoprostol Monotherapy for the Management of Miscarriage: A Cost-Effectiveness Analysis. Obstetrics and Gynecology : 10 Sep 2020. Available from: URL: http://doi.org/10.1097/AOG.0000000000004063
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PharmacoEconomics & Outcomes News 3 Oct 2020 No. 863
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