Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso Trial

Research output: Contribution to journalArticlepeer-review

Authors

External organisations

  • Miscarriage Association
  • Tommy’s
  • City Hospitals Sunderland NHS Foundation Trust, Sunderland, SR4 7TP
  • Sunderland Royal Hospital
  • Royal Victoria Infirmary
  • West Middlesex University Hospital
  • University Hospital Coventry
  • Burnley General Hospital
  • Queen Charlotte's and Chelsea Hospital
  • University College Hospital
  • King's College Hospital NHS Foundation Trust
  • University of Liverpool
  • University of Southampton
  • Whipps Cross Hospital
  • Royal Infirmary of Edinburgh
  • University of Edinburgh, The
  • Warwick Medical School

Abstract

Objective: To assess the cost‐effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage.

Design: Within‐trial economic evaluation and model‐based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using non‐parametric bootstrapping and reported using cost‐effectiveness acceptability curves. Analyses were performed from the NHS perspective.

Setting: 28 UK NHS early pregnancy units.

Participants: 711 women aged 16‐39 years with ultrasound evidence of a missed miscarriage.

Interventions: Mifepristone and misoprostol or matched placebo and misoprostol tablets.

Main Outcome Measures: Cost per additional successfully managed miscarriage and QALYs.
Results: For the within‐trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI: 0.7% to 12.5%) per successfully managed miscarriage and QALYs difference of 0.04% (95% CI: ‐0.01% to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost‐saving of £182 (95% CI: £26 to £338). Hence, MifeMiso intervention dominated the use of misoprostol alone.

The model‐based analysis showed that MifeMiso intervention is dominant compared to expectant management and the current medical management strategy. However, the model‐based evidence suggests that the intervention is a less effective but less costly strategy than surgical management.

Conclusions: The within‐trial analysis found that based on cost‐effectiveness grounds, MifeMiso intervention is likely to be recommended by decision‐makers for the medical management of women presenting with a missed miscarriage.

Details

Original languageEnglish
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Early online date10 May 2021
Publication statusE-pub ahead of print - 10 May 2021

Keywords

  • Economic evaluation, cost‐effectiveness, cost‐utility, model, miscarriage, management