Cost-effectiveness of cytogenetic evaluation of products of conception in the patient with a second pregnancy loss

摘要

Objective: To compare the cost of two strategies for managing the patient with recurrent pregnancy loss (RPL). Design: Cost analysis using a decision analytic model was used to compare obtaining an evidence-based workup (EBW) for RPL versus obtaining a karyotype of the products of conception (POC) and proceeding with an EBW only in the setting of euploid POC. Setting: Outpatient care. Patient(s): A simulated cohort of patients experiencing a second pregnancy loss. Intervention(s): Not applicable. Main Outcome Measure(s): Total cost of investigating the cause of RPL after a second pregnancy loss. Result(s): For all age categories, obtaining a karyotype of POC was less costly than an evidenced-based RPL evaluation. Monte Caro analysis demonstrated a net economic benefit for the karyotype strategy ($4,498 [±$792] vs. $5,022 [±$1,130]). Conclusion(s): Our model suggests an economic advantage for obtaining a karyotype of POC in women with second miscarriage.