Pharmacological treatment of ectopic pregnancy : Accuracy, safety and cost-effectiveness of day 1-7 β-hCG measurements
© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics..
OBJECTIVE: The aim of the present study was to compare accuracy, safety and cost-effectiveness of three β-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 β-hCG levels, (2) day 1 to 4 β-hCG levels and (3) day 4 to 7 β-hCG levels.
METHODS: Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve.
RESULTS: A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in β-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient.
CONCLUSION: Patients treated with MTX for EP, measurement of day 1 and day 7 β-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics - (2024) vom: 15. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dayan-Schwartz, Adi [VerfasserIn] |
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| Links: |
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| Themen: |
β‐hCG |
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| Anmerkungen: |
Date Revised 15.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1002/ijgo.15511 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Pharmacological treatment of ectopic pregnancy |b Accuracy, safety and cost-effectiveness of day 1-7 β-hCG measurements |
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| 520 | |a © 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. | ||
| 520 | |a OBJECTIVE: The aim of the present study was to compare accuracy, safety and cost-effectiveness of three β-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 β-hCG levels, (2) day 1 to 4 β-hCG levels and (3) day 4 to 7 β-hCG levels | ||
| 520 | |a METHODS: Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve | ||
| 520 | |a RESULTS: A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in β-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient | ||
| 520 | |a CONCLUSION: Patients treated with MTX for EP, measurement of day 1 and day 7 β-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a early pregnancy | |
| 650 | 4 | |a ectopic pregnancy | |
| 650 | 4 | |a extra uterine pregnancy (EUP) | |
| 650 | 4 | |a hospital congestion | |
| 650 | 4 | |a methotrexate (MTX) | |
| 650 | 4 | |a treatment costs | |
| 650 | 4 | |a β‐hCG | |
| 700 | 1 | |a Abd Elgani, Suzan |e verfasserin |4 aut | |
| 700 | 1 | |a Abdul-Ghani, Tamam |e verfasserin |4 aut | |
| 700 | 1 | |a Kogan, Liron |e verfasserin |4 aut | |
| 700 | 1 | |a Reiss, Ari |e verfasserin |4 aut | |
| 700 | 1 | |a Tal, Alon |e verfasserin |4 aut | |
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