Cost-effectiveness of dilation and evacuation versus the induction of labor for second-trimester pregnancy termination

American Journal of Obstetrics and Gynecology
Allison A CowettWilliam A Grobman

Abstract

The purpose of this study was to compare the cost-effectiveness of dilation and evacuation versus misoprostol induction of labor for second-trimester termination. Using decision analysis, we compared the cost-effectiveness of dilation and evacuation and misoprostol induction of labor for second-trimester termination. Complications for dilation and evacuation and induction of labor included repeat dilation and curettage, cervical laceration repair, hospital admission, laparotomy, hysterectomy, and maternal death. Induction of labor complications also included failed induction of labor. The primary outcome was cost per quality-adjusted life year. Sensitivity analyses were performed for all relevant variables. Dilation and evacuation was less costly and more effective than misoprostol induction of labor for second-trimester termination with baseline estimates. In 1-way sensitivity analysis, the model was robust to all variation in probabilities and costs. In Monte Carlo simulation with 1000 trials and a cost-effectiveness threshold of $50,000/quality-adjusted life year, dilation and evacuation was the preferred approach in 97.9% of trials. Dilation and evacuation is less expensive and more effective than misoprostol induction of l...Continue Reading

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Citations

Aug 22, 2006·Obstetrical & Gynecological Survey·William A Grobman
Jul 28, 2010·Clinical Obstetrics and Gynecology·Robert M Silver, Cara C Heuser
Jun 15, 2011·Contraception·Lynn BorgattaUNKNOWN Society of Family Planning
Apr 3, 2012·Contraception·Maryam GuiahiCarolyn L Westhoff
Mar 31, 2010·Best Practice & Research. Clinical Obstetrics & Gynaecology·Raffaele Napolitano, Basky Thilaganathan
Feb 19, 2008·Contraception·David K TurokRobert M Silver
Sep 6, 2015·Seminars in Perinatology·Nahida A Chakhtoura, Uma M Reddy
Dec 7, 2013·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Regina-Maria RennerDalia Brahmi
Nov 16, 2011·American Journal of Obstetrics and Gynecology·Kari A WhitleyMeredith L Rochon
Mar 26, 2009·American Journal of Obstetrics and Gynecology·Cassing Hammond
Sep 17, 2008·Reproductive Health Matters·Patricia A Lohr
Sep 17, 2008·Reproductive Health Matters·David A Grimes
May 1, 2015·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Jeremy D Goldhaber-Fiebert, Margaret L Brandeau
Oct 15, 2011·Gynecologic and Obstetric Investigation·Wei XiaTai Hing Lam
May 9, 2014·Obstetrics and Gynecology·Alisa B Goldberg
Jan 10, 2014·Journal of Graduate Medical Education·Maryam GuiahiKimberly Kenton

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