TREATMENT OF THE SMALL UNRUPTURED ECTOPIC PREGNANCY - A COST-ANALYSISOF METHOTREXATE VERSUS LAPAROSCOPY

Objective: To compare the economic costs between two strategies for ma nagement of the small unruptured ectopic pregnancy: initial treatment with methotrexate versus initial treatment with laparoscopic salpingos tomy. Methods: We assumed that both treatment strategies would result in identical clinical outcomes: resolution of the ectopic pregnancy wi thout 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/m(2)) and for the likely clini cal outcomes of the laparoscopy strategy. A range of values was evalua ted for the initial success rate of each strategy and varying assumpti ons made about the type of treatment modality used for initial treatme nt failures. Direct medical costs of each strategy were estimated base d on actual reimbursement rates of a third-party payer for the compone nts of each strategy. The treatment strategies were compared in best-c ase/worst-case scenarios to determine the potential range of differenc es in costs between the two strategies. Results: The cost of the metho trexate strategy ranged from $438 to $1390, and the cost of laparoscop ic salpingostomy ranged from $2506 to $2974; therefore, the methotrexa te strategy was less costly than laparoscopy, with a cost difference r anging from $1124 (best-case laparoscopy-worst-case methotrexate scena rio) to $2536 (worst-case laparoscopy-best-case methotrexate scenario) . Sensitivity analyses demonstrated that initial therapy with methotre xate was less costly over a wide range of probability and cost estimat es. Conclusion: Initial methotrexate is a cost-effective alternative t o laparoscopic salpingostomy in the treatment of the small unruptured ectopic pregnancy.