MIFEPRISTONE IN MID-TRIMESTER TERMINATION OF PREGNANCY - VALUE FOR MONEY

Objective. A cost comparison between two regimes of mid-trimester medi cal termination of pregnancy (MTOP), using gemeprost following pre-tre atment with prostaglandin E(2) gel, (PGE2) and after pre-treatment wit h mifepristone. Design. A prospective observational study of women und ergoing second trimester termination of pregnancy during 1992-1993. Th e cost effectiveness of two alternative treatment methods is assessed. Setting. A district general maternity hospital. Subjects. 34 women we re pre-treated with vaginal PGE2 gel prior to gemeprost vaginal pessar ies for MTOP in 1992 (Group A); 31 women in 1993 were pre-treated with mifepristone prior to gemeprost administration (Group B). Main outcom e measures. A clinical and economic evaluation of two methods of MTOP. Results. Following pre-treatment with mifepristone, there was a signi ficant reduction in the median induction to abortion interval (6 hr vs 14.2 hr; p<0.0001). Incomplete abortion occurred in an equal proporti on of women (5/34 vs 5/31; p=1.00). the majority of the women pre-trea ted with mifepristone (28/31) went home within 24 hours compared to tw o (2/34) in the gemeprost group. The median cost of TOP was pound 420 in mifepristone group compared to pound 885 in PGE2 group (p<0.0001). Conclusion. Pre-treatment with mifepristone in the second trimester te rmination of pregnancy results in significant reduction in induction t o abortion interval and substantial savings in the cost of treatment.