Cost Analysis of Single Versus Dual Agent Therapy in Management of Early Pregnancy Loss [ID 1604]

INTRODUCTION: Early pregnancy loss (EPL) occurs in 10% of pregnancies and is managed expectantly, medically, or with a procedure. Medical management with dual agents (mifepristone and misoprostol) is more effective than single-agent therapy for EPL, but it may be costly. Our research uses statistical modeling to investigate if combination therapy is more cost-effective than single-agent therapy for EPL management. METHODS: A Monte Carlo simulation used 1,000 theoretical patients treated with single-agent therapy versus 1,000 treated with dual-agent therapy. A total of 20,000 random draws were used from the theoretical binomial distributions of success, defined as complete abortion. Costs of medication and incidence of complications were derived from published studies, supplemented with internal hospital costs, and inflated to 2023 U.S. dollars. The incremental cost-effectiveness ratio (ICER) was then calculated. RESULTS: Single-agent therapy cost $349,189 with a 79.34% success rate, whereas dual-agent therapy cost $125,049 with a 92.85% success rate. The ICER was dominant at −$1,660. Additionally, the ICER is more dominant (−$1,936) if dual-agent therapy is used a second time if medical management initially fails. CONCLUSIONS/IMPLICATIONS: In this simulation, dual-agent therapy is dominant: It is both more effective and less expensive for management of EPL when compared to single-agent therapy. This suggests dual-agent therapy should be the preferred medication regimen for management of EPL. Our model confirms the findings of previously published works, suggesting universal adoption of dual-agent therapy to be both a more successful and cost-effective method of EPL management.