在资源丰富环境下由助产士或医生提供的药物流产：一项成本效益分析。
Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.
作者信息
Sjöström Susanne, Kopp Kallner Helena, Simeonova Emilia, Madestam Andreas, Gemzell-Danielsson Kristina
机构信息
Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Department of Clinical Sciences at Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
出版信息
PLoS One. 2016 Jun 30;11(6):e0158645. doi: 10.1371/journal.pone.0158645. eCollection 2016.
OBJECTIVE
The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established.
STUDY DESIGN
A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden.
RESULTS
The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided.
CONCLUSION
Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women's access to safe abortion.
目的
本研究的目的是计算在超声检查作为方案一部分的高资源环境中，由助产士进行早期药物流产与医生进行早期药物流产相比的成本效益。此前已有研究表明，非医生医疗保健专业人员提供药物流产的效果和安全性与医生相当，但这种任务转移的成本效益仍有待确定。
研究设计
基于一项先前发表的随机对照等效性研究的数据进行成本效益分析，该研究包括1180名健康女性，她们被随机分配到标准程序组（由医生提供早期药物流产）或干预组（由助产士提供）。确定了1.6%的疗效风险差异，定义为无需手术干预的完全流产，有利于助产士提供服务，这意味着每100例手术中，干预治疗导致需要手术干预的不完全流产比标准治疗少1.6例。计算了平均直接和间接成本以及增量成本效益比（ICER）。该研究在瑞典斯德哥尔摩的一家大学医院进行。
结果
干预组每例手术的平均直接成本为45欧元，而标准程序组为58.3欧元。干预措施的成本和疗效均优于标准治疗，基于直接成本计算的ICER为-831欧元，考虑到每避免一次手术干预的总成本，ICER为-1769欧元。
结论
助产士提供的早期药物流产比医生提供的更具成本效益。这一证据为临床医生和决策者提供了一个重要工具，可能会影响政策和临床实践，并最终增加堕胎提供者的数量，减少女性获得安全堕胎的一个障碍。
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