{"id":6529,"date":"2021-06-04T12:21:30","date_gmt":"2021-06-04T11:21:30","guid":{"rendered":"https:\/\/www.library.sath.nhs.uk\/research\/?p=6529"},"modified":"2025-11-25T09:53:19","modified_gmt":"2025-11-25T09:53:19","slug":"cost-effectiveness-of-mifepristone-and-misoprostol-versus-misoprostol-alone-for-the-management-of-missed-miscarriage-an-economic-evaluation-based-on-the-mifemiso-trial-2021","status":"publish","type":"post","link":"https:\/\/www.library.sath.nhs.uk\/research\/2021\/06\/04\/cost-effectiveness-of-mifepristone-and-misoprostol-versus-misoprostol-alone-for-the-management-of-missed-miscarriage-an-economic-evaluation-based-on-the-mifemiso-trial-2021\/","title":{"rendered":"Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso Trial (2021)"},"content":{"rendered":"

Type of publication:<\/strong>
\nJournal article<\/p>\n

Author(s):<\/strong>
\nOkeke Ogwulu, C B; Williams, E V; Chu, J J; Devall, A J; Beeson, L E; Hardy, P; Cheed, V; Yongzhong, S; Jones, L L; La Fontaine Papadopoulos, J H; Bender-Atik, R; Brewin, J; Hinshaw, K; Choudhary, M; Ahmed, A; Naftalin, J; Nunes, N; Oliver, A; Izzat, F; Bhatia, K; Hassan, I; Jeve, Y; Hamilton, J; Deb, S; Bottomley, C; Ross, J; Watkins, L; *Underwood, M; Cheong, Y; Kumar, C S; Gupta, P; Small, R; Pringle, S; Hodge, F S; Shahid, A; Horne, A W; Quenby, S; Gallos, I D; Coomarasamy, A; Roberts, T E<\/p>\n

Citation:<\/strong>
\nBJOG : an international journal of obstetrics and gynaecology; 2021 Aug;128(9):1534-1545.<\/p>\n

Abstract:<\/strong>
\nOBJECTIVE 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.SETTING28 UK NHS early pregnancy units.PARTICIPANTS711 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 \u00a3182 (95% CI: \u00a326 to \u00a3338). 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.<\/p>\n

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