Cost-effectiveness of single-dose methotrexate compared with laparoscopic treatment of ectopic pregnancy

Abstract

Single-dose methotrexate is a cost-saving, nonsurgical, fallopian tube-sparing treatment for ectopic pregnancy.

Medical treatment of ectopic pregnancy

“…Primary surgical therapy is favored when the likelihood of failure or morbidity from medical treatment is high and when the time to resolution is likely to be prolonged. Such cases generally are characterized by high initial hCG levels and/or the presence of embryonic cardiac activity (56,57). …”

Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy

“…Although it has not been approved by the Food and Drug Administration for this indication, its use has been endorsed by the American College of Obstetrics and Gynecology and is considered first-line therapy at many institutions (4). Medical management of an EP has been demonstrated to be more cost-effective than surgical management (5)(6)(7)(8)(9), with similar outcomes with respect to the rate of success of treatment, tubal patency, and future reproductive outcome (2,10,11).…”

Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis

“…Indeed, these conservative treatments gave better outcomes at equal or lower cost to the healthcare system. This finding, which was partly expected from cost studies indicating the superiority of methotrexate (6,8,10,12,18,19) and from fertility studies indicating the superiority of all conservative treatments (20,21), has clear consequences in terms of recommendations for practice. When future fertility is at stake (i.e., when EP results from a reproductive failure), in practice, conservative treatments should be preferred, with methotrexate used whenever possible, for subacute cases (about 80% of all cases) that have a positive diagnostic ultrasound (currently only about 50% of subacute cases).…”