Direct cost of single dose methotrexate for unruptured ectopic pregnancy -Prospective comparison with laparoscopy

Objectives: to compare the direct cost of single dose methotrexate (MTX) an d laparoscopy in the treatment of unruptured ectopic pregnancy (unruptured EP). Study design: A prospective nonrandomized study. Thirty-two women rece ived intramuscular MTX (1 mg/kg) on an out-patient basis when they fulfille d the following requirements: human chorionic gonadotropin (hCG) level <500 0 IU/l, hematosalpinx diameter <3 cm and peritoneal fluid <100 cc. Follow-u p consisted of clinical controls and hCG assays. Twenty-seven women eligibl e for MTX therapy according to the above conditions underwent laparoscopic salpingectomy because some of them refused the therapy while others had con traindications to MTX. We recorded all the medical expenses related to the out-patient and in-patient management for the two treatment options, The co st was calculated according to the French General Nomenclature of Professio nal Acts and expressed in Euros. Results: MTX resulted in a significantly l ower mean direct cost in comparison with surgery (E 1145 vs. 2442, P=0.006) that was mainly due to shortened hospital stay (1.1 vs. 2.8 days, P=0.007) . Conversely MTX required a significantly higher number of medical acts dur ing the follow-up. Costs for MTX therapy were closely related to the length of hospitalization and to the duration of the follow-up. Conclusion: Singl e dose MTX provides significant cost-savings when compared to laparoscopy. Savings reach a peak for small unruptured EP because hospitalization is not required and the length of follow-up reduced. (C) 2000 Elsevier Science Ir eland Ltd, All rights reserved.