Abstract
Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding.
Design: Economic evaluation alongside a large multicentre randomised placebo-controlled trial. Setting: 48 UK NHS early pregnancy units.
Population: 4153 women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac.
Methods: An incremental cost-effectiveness analysis was performed from a National Health Service (NHS) and NHS and Personal Social Services perspectives. Sensitivity analyses and subgroup analysis on women with ≥1 and ≥3 previous miscarriages were carried out.
Main Outcome Measures: Cost per additional live-birth at ≥34 weeks’ gestation.
Results: Progesterone intervention from the trial led to an effect difference of 0.022 (95% CI: -0.004 to 0.050). The mean cost per woman in the progesterone group was £76 (95% CI: -£559 to £711) more than placebo. The incremental cost-effectiveness ratio for progesterone compared to placebo was £3305 per additional live-birth. For women with at least one previous miscarriage progesterone was more effective than placebo with an effect difference 0.055 (95% CI: 0.014 to 0.096) and this is associated with a cost saving of £322 (95% CI: -£1318 to £ 673).
Conclusions: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable especially, for women who had ≥1 previous miscarriage. Given our findings, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s).
Design: Economic evaluation alongside a large multicentre randomised placebo-controlled trial. Setting: 48 UK NHS early pregnancy units.
Population: 4153 women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac.
Methods: An incremental cost-effectiveness analysis was performed from a National Health Service (NHS) and NHS and Personal Social Services perspectives. Sensitivity analyses and subgroup analysis on women with ≥1 and ≥3 previous miscarriages were carried out.
Main Outcome Measures: Cost per additional live-birth at ≥34 weeks’ gestation.
Results: Progesterone intervention from the trial led to an effect difference of 0.022 (95% CI: -0.004 to 0.050). The mean cost per woman in the progesterone group was £76 (95% CI: -£559 to £711) more than placebo. The incremental cost-effectiveness ratio for progesterone compared to placebo was £3305 per additional live-birth. For women with at least one previous miscarriage progesterone was more effective than placebo with an effect difference 0.055 (95% CI: 0.014 to 0.096) and this is associated with a cost saving of £322 (95% CI: -£1318 to £ 673).
Conclusions: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable especially, for women who had ≥1 previous miscarriage. Given our findings, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s).
| Original language | English |
|---|---|
| Number of pages | 11 |
| Journal | BJOG: An International Journal of Obstetrics and Gynaecology |
| Early online date | 30 Jan 2020 |
| DOIs | |
| Publication status | E-pub ahead of print - 30 Jan 2020 |
Keywords
- Economic evaluation
- cost-effectiveness
- miscarriage
- progesterone