Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial.

To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage. 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 nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS). Twenty-eight UK NHS early pregnancy units. A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage. Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets. Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs). For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a 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 £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is 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. The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage. The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages. © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Citation

C B Okeke Ogwulu, E V Williams, J J Chu, A J Devall, L E Beeson, P Hardy, V Cheed, S Yongzhong, L L Jones, J H La Fontaine Papadopoulos, R Bender-Atik, J Brewin, K Hinshaw, M Choudhary, A Ahmed, J Naftalin, N Nunes, A Oliver, F Izzat, K Bhatia, I Hassan, Y Jeve, J Hamilton, S Debs, C Bottomley, J Ross, L Watkins, M Underwood, Y Cheong, C S Kumar, P Gupta, R Small, S Pringle, F S Hodge, A Shahid, A W Horne, S Quenby, I D Gallos, A Coomarasamy, T E Roberts. Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial. BJOG : an international journal of obstetrics and gynaecology. 2021 Aug;128(9):1534-1545

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PMID: 33969614

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