Alexander J M, Rouse D J, Varner E, Austin J M
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Obstet Gynecol. 1996 Jul;88(1):123-7. doi: 10.1016/0029-7844(96)00086-5.
To compare the economic costs between two strategies for management of the small unruptured ectopic pregnancy: initial treatment with methotrexate versus initial treatment with laparoscopic salpingostomy.
We assumed that both treatment strategies would result in identical clinical outcomes: resolution of the ectopic pregnancy without maternal mortality or long-term morbidity. Based on a literature review, estimates were derived for the likely clinical outcomes of a single injection of methotrexate (50 mg/m2) and for the likely clinical outcomes of the laparoscopy strategy. A range of values was evaluated for the initial success rate of each strategy and varying assumptions made about the type of treatment modality used for initial treatment failures. Direct medical costs of each strategy were estimated based on actual reimbursement rates of a third-party payer for the components of each strategy. The treatment strategies were compared in best-case/worst-case scenarios to determine the potential range of differences in costs between the two strategies.
The cost of the methotrexate strategy ranged from $438 to $1390, and the cost of laparoscopic salpingostomy ranged from $2506 to $2974; therefore, the methotrexate strategy was less costly than laparoscopy, with a cost difference ranging from $1124 (best-case laparoscopy-worst-case methotrexate scenario) to $2536 (worst-case laparoscopy-best-case methotrexate scenario). Sensitivity analyses demonstrated that initial therapy with methotrexate was less costly over a wide range of probability and cost estimates.
Initial methotrexate is a cost-effective alternative to laparoscopic salpingostomy in the treatment of the small unruptured ectopic pregnancy.
比较两种治疗小的未破裂异位妊娠策略的经济成本：甲氨蝶呤初始治疗与腹腔镜输卵管造口术初始治疗。
我们假设两种治疗策略会产生相同的临床结果：异位妊娠得以解决，且无孕产妇死亡或长期发病情况。基于文献综述，得出单次注射甲氨蝶呤（50 mg/m²）可能的临床结果以及腹腔镜手术策略可能的临床结果的估计值。对每种策略的初始成功率评估了一系列数值，并对初始治疗失败时所采用的治疗方式类型做出了不同假设。根据第三方支付方对每种策略各组成部分的实际报销率估算每种策略的直接医疗成本。在最佳/最差情况下对治疗策略进行比较，以确定两种策略成本差异的潜在范围。
甲氨蝶呤策略的成本在438美元至1390美元之间，腹腔镜输卵管造口术的成本在2506美元至2974美元之间；因此，甲氨蝶呤策略的成本低于腹腔镜手术，成本差异在1124美元（最佳情况腹腔镜手术 - 最差情况甲氨蝶呤策略）至2536美元（最差情况腹腔镜手术 - 最佳情况甲氨蝶呤策略）之间。敏感性分析表明，在广泛的概率和成本估计范围内，甲氨蝶呤初始治疗成本更低。
在治疗小的未破裂异位妊娠方面，初始使用甲氨蝶呤是腹腔镜输卵管造口术具有成本效益的替代方法。
