Cost of medical treatment with methotrexate for ectopic pregnancy. Comparative study medical versus conservative laparoscopy. Experience of Aziza Othmana’s Hospital

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Published Mar 6, 2013
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Vol. 91 No. 2 (2013): Issue Feb 2013

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Anis Fadhlaoui
Hanène Oueslati
Zied Khedhiri
Mohamed Khrouf
Anis Chaker
Fethi Zhioua

Abstract

Background: The ectopic pregnancy can be treated surgically (conservative or radical) or medically. Currently, the choice between medical and surgical treatment is a critical issue. One of the parameters of this choice is the total cost of management.
Aim: To compare the cost of the management of ectopic pregnancy by medical treatment (methotrexate, MTX) and coeliochirurgicaux.
Methods: This is a prospective, comparative, nonrandomized,unicentric study, on 39 patients who have ectopic pregnancies treated with MTX versus 16 patients treated by laparoscopic surgery with conservative treatment. This study was collected at the service of Obstetrics and Gynecology Reproductive Medicine Aziza Othmana Hospital (Tunis) for a period of two years.
Results: The average cost of hospital stay per patient was 549.38 dt for the MTX group against 268.39 dt for laparoscopic surgery group (p <0.001). There was no statistically significant difference between the two groups. In terms of overall absenteeism, there is no statistically significant difference (16.43 vs 17.5 days).
Conclusion: The initial treatment with MTX costs more cost than the conservative laparoscopic treatment and this is mainly due to the long period of hospitalization.

Keywords:

Ectopic pregnancy, methotrexate, laparoscopy, conservative treatment, cost.

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References

  1. Coste J, Bouyer J, Ughetto S, Fernadez H. Ectopic pregnancy is again on the increase. Recent trends in the incidence of ectopic pregnancy in France (1992-2002). Hum Reprod 2004; 19:2014- 2018.
  2. M. Canis, D. Savary, J. L. Pouly, A. Wattiez, G. Mage. Grossesse extra-utérine: critères de choix du traitement médical ou du traitement chirurgical. J Gynecol Obstet Biol Reprod 2003; 32 (suppl. au n°7): 3S54-3S63.
  3. Mol BW, Hajenius PJ, Engelsbel S, et al. Treatment of tubal pregnancy in the Netherlands: an economic comparison of systemic méthotrexate administration and laparoscopic salpingostomy. Am J Obstet Gynecol 1999; 181:945-51.
  4. Sowter MC, Farquhar CM, Gudex G. An economic evaluation of single dose systemic méthotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. BJOG 2001; 108:204-12.
  5. Fernandez H, Capella-Allouc S, Vincent Y, Pauthier S, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility. Hum Reprod 1998; 13: 3239-43.
  6. Saraj AJ, Wilcox JG, Najmabadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular méthotrexate with salpingostomy. Obstet Gynecol 1998; 92:989- 94.
  7. Dias Preira G, Hajenius PJ, Mol BW, et al. Fertility outcome after systemic méthotrexate and laparoscopic salpingostomy for tubal pregnancy. Lancet 1999; 353:724-5.
  8. Kumtepe Y, Kadanali S. Medical treatement of ruptured with hemodynamically stable and unruptured ectopic pregnancy patients. Eur J Obstet Gynecol Reprod Biol. 2004, 116; 221-25.
  9. El-Sherbiny MT, Mera IM. Methotrexate versus laparoscopic surgery for the management of unruptured tubal pregnancy. Middle East Fertil Soc J 2003; 8:256-262.
  10. Laibl. V, Takacs P, Kang J. Previous ectopic pregnancy as a predictor of méthotrexate failure. Int J Gynaecol Obstet 2004; 85:177-178.
  11. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic méthotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG 2001; 108:192-203.
  12. Vaissade L, Gerbaud L, Pouly JL, et al. Comparaison coûteffectivité de la coeliochirurgie versus le traitement médical au méthotrexate, à partir du registre des grossesses extra-utérines d'Auvergne. J Gynecol Obstet Biol Reprod 2003 ; 32 :447-458.