Clinical Effectiveness and Cost-Effectiveness of Misoprostol in Comparison to Dilatation and Curettage for Treatment of First-Trimester Missed Abortion (Gestational Age ≤ 14 Weeks) in Iran.

Background and Aims: The development of prostaglandins and antiprogestins revolutionized medical abortion by providing effective nonsurgical options for terminating pregnancy. Although both strategies are accepted in practice, variations in clinical efficacy, patient experiences, and associated costs significantly influence their overall effectiveness. We aimed to evaluate the cost-effectiveness of hospital- and clinic-based misoprostol administration (as a medical intervention) compared to dilation and curettage (D&C) as a surgical intervention for early pregnancy termination in Iran. Methods: This cost-effectiveness study was conducted based on clinical data from a self-designed quasi-experimental research study in three Iranian hospitals, spanning from August 1, 2021 to March 30, 2022. Participants included 168 women diagnosed with induced abortion in early pregnancy (≤ 14 weeks of gestation). We calculated costs, outcomes (Quality-Adjusted Life Years), and incremental cost-effectiveness ratios (ICER) from a societal perspective over a 14-day time horizon starting from the date of initiation of treatment. A decision tree model using TreeAge Pro Healthcare software 2022 was employed. Results: The overall societal costs of hospital-based misoprostol, D&C, and clinic-based misoprostol strategies were estimated at $135.1, $138.3, and $158.2, respectively. The QALYs for hospital-based misoprostol, clinic-based misoprostol, and D&C were estimated at 0.6891, 0.3947, and 0.6604, respectively. The ICERs of D&C and clinic-based misoprostol strategies were calculated as $109 and $79 per QALY, respectively. Conclusion: This study indicates that using misoprostol administered in hospitals for first-trimester induced abortions in Iran not only reduces societal costs but also improves quality of life compared to both D&C procedures and clinic-based misoprostol administration.