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Tuesday, October 21, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Purpose: In April 2007, abortion was legalized in Mexico City for women seeking to terminate pregnancy up to 12 weeks gestation. The WHO recommends manual vacuum aspiration (MVA) provided the regimen is safe, affordable, and accessible, but current clinical practice in Mexico is largely dilatation and curettage (D&C). To inform policy decisions on the expansion of abortion services in Mexico City , we conducted a comparative analysis of the health and economic outcomes associated with three alternative first-trimester abortion techniques.
Methods: We developed a computer-based decision analytic model to simulate induced abortion and its potential complications in a representative cohort of 25-year-old Mexican women seeking pregnancy termination up to 12 weeks gestation. Strategies were (1) dilatation and curettage (D&C), (2) manual vacuum aspiration (MVA) and (3) medical abortion (MA) using vaginal misoprostol alone. Data were from national databases and the literature. The main analysis was conducted through the perspective of the health care system, but the impact of patient costs was considered in a separate analysis. .
Results: The least costly and effective strategy was medical abortion which had a total discounted average lifetime per-person cost of $98 and quality-adjusted life-expectancy of 25.94 years. In comparison, MVA was more effective (quality-adjusted life expectancy of 26.11) but also more costly ($110), and had an incremental cost-effectiveness ratio (ICER) of $62 per quality-adjusted life year (QALY) gained. D&C was less effective but more costly than MVA, was therefore strongly dominated. Results were sensitive to varying the relative efficacy, safety, and cost of medical abortion. When patient time and transportation costs were included in the analysis, medical abortion becomes more attractive.
Conclusions: The most effective strategy for safe, first trimester abortion in Mexico City is MVA; from a health care perspective this strategy has a cost-effectiveness ratio that is well under the per-capita GDP. These results support a shift from D&C to MVA as the preferred surgical modality. A national strategy that provides access to both MVA and medical abortion, allowing women to choose their preferred modality, has the best chance to reduce abortion-related morbidity and mortality.
Methods: We developed a computer-based decision analytic model to simulate induced abortion and its potential complications in a representative cohort of 25-year-old Mexican women seeking pregnancy termination up to 12 weeks gestation. Strategies were (1) dilatation and curettage (D&C), (2) manual vacuum aspiration (MVA) and (3) medical abortion (MA) using vaginal misoprostol alone. Data were from national databases and the literature. The main analysis was conducted through the perspective of the health care system, but the impact of patient costs was considered in a separate analysis. .
Results: The least costly and effective strategy was medical abortion which had a total discounted average lifetime per-person cost of $98 and quality-adjusted life-expectancy of 25.94 years. In comparison, MVA was more effective (quality-adjusted life expectancy of 26.11) but also more costly ($110), and had an incremental cost-effectiveness ratio (ICER) of $62 per quality-adjusted life year (QALY) gained. D&C was less effective but more costly than MVA, was therefore strongly dominated. Results were sensitive to varying the relative efficacy, safety, and cost of medical abortion. When patient time and transportation costs were included in the analysis, medical abortion becomes more attractive.
Conclusions: The most effective strategy for safe, first trimester abortion in Mexico City is MVA; from a health care perspective this strategy has a cost-effectiveness ratio that is well under the per-capita GDP. These results support a shift from D&C to MVA as the preferred surgical modality. A national strategy that provides access to both MVA and medical abortion, allowing women to choose their preferred modality, has the best chance to reduce abortion-related morbidity and mortality.
See more of: Poster Session IV
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)