MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
BMC Pregnancy Childbirth. 2012 Sep 17;12:98. doi: 10.1186/1471-2393-12-98.
There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP), especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate.
We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1) investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2) to compare the cost of medical management for women with hCG concentrations 1500-3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1) those who had initial medical management with methotrexate, (2) those who were eligible for initial medical management but chose surgery ('elected' surgery) and (3) those who initially 'required' surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS) in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method.
Methotrexate was £1179 (CI 819-1550) per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures.
Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.
对于异位妊娠（EP）的管理，甲氨蝶呤的成本效益存在争议，特别是对于血清人绒毛膜促性腺激素（hCG）水平>1500IU/L 的患者。我们假设，随着甲氨蝶呤治疗经验的增加和基于指南的方案的广泛应用，其管理的直接成本已经降低。
我们对一家英国大型教学医院接受 EP 治疗的女性进行了回顾性成本分析，旨在（1）调查对于适合两种治疗方法的患者，药物治疗的成本是否低于手术治疗；（2）比较血清 hCG 浓度为 1500-3000IU/L 的女性药物治疗成本与选择手术的相似 hCG 浓度女性的治疗成本。确定了三个不同的治疗组：（1）最初接受甲氨蝶呤药物治疗的患者；（2）最初适合药物治疗但选择手术的患者（“选择”手术）；（3）最初“需要”手术且不符合甲氨蝶呤治疗条件的患者。我们从英国国民保健制度（NHS）的角度计算了成本。我们使用平均值、标准差、中位数和范围来总结每个研究组的成本，并使用非参数自举法计算差异成本的 95%置信区间，以考虑到数据的偏态性质。
甲氨蝶呤的成本比手术便宜 1179 英镑（819-1550 英镑），但由于治疗失败，血清 hCG>1500IU/L 的女性接受甲氨蝶呤治疗并没有显著节省成本。
我们的数据支持对于 hCG>1500IU/L 的 EP 更好的药物治疗存在持续的未满足的经济需求。
