Okeke 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, Debs 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
Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
BJOG. 2021 Aug;128(9):1534-1545. doi: 10.1111/1471-0528.16737. Epub 2021 Jun 7.
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.
评估米非司酮与米索前列醇联合用药（米非米索）相较于单纯使用米索前列醇用于稽留流产药物治疗的成本效益。
试验内经济评估及基于模型的分析，以便将研究结果置于一系列对照物更广泛经济证据的背景下。使用非参数自抽样法计算增量成本和结果，并使用成本效益可接受性曲线进行报告。分析是从英国国家医疗服务体系（NHS）的角度进行的。
英国28个NHS早期妊娠单元。
一组711名年龄在16至39岁之间、经超声检查证实为稽留流产的女性。
采用米非司酮与米索前列醇联合治疗或匹配的安慰剂与米索前列醇片治疗。
每成功治疗一例稽留流产的成本及质量调整生命年（QALY）。
在试验内分析中，米非米索干预组每成功治疗一例稽留流产的绝对效应差异为6.6%（95%可信区间0.7%-12.5%），QALY差异为0.04%（95%可信区间-0.01%至0.1%）。米非米索组每成功治疗一例稽留流产的平均成本低于安慰剂与米索前列醇组，节省成本182英镑（95%可信区间26英镑至338英镑）。因此，米非米索干预优于单纯使用米索前列醇。基于模型的分析表明，与期待治疗相比，米非米索干预更可取，而这是当前的药物治疗策略。然而，基于模型的证据表明，该干预与手术治疗相比效果较差但成本较低。
试验内分析发现，基于成本效益原则，决策者可能会推荐米非米索干预用于稽留流产女性的药物治疗。
米非司酮与米索前列醇联合用药治疗稽留流产比单纯使用米索前列醇更有效且成本更低。
