The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial

C B Okeke Ogwulu, I Goranitis, J E Norman, et al.

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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).

Original languageEnglish
Number of pages11
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Early online date30 Jan 2020
DOIs
Publication statusE-pub ahead of print - 30 Jan 2020

Keywords

  • Economic evaluation
  • cost-effectiveness
  • miscarriage
  • progesterone

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