The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial

Tracy Roberts; Duby Okeke Ogwulu; Ilias Goranitis; Adam Devall; Versha Cheed; Ioannis Gallos; Lee Middleton; Hoda Harb; Helen Williams; Abey Eapen; Jane Daniels; A  Ahmed; R Bender atik; K Bhatia; C bottomley; Andrew Ewer; Arri Coomarasamy

doi:DOI: 10.1111/1471-0528.16068

The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial

Tracy Roberts, Duby Okeke Ogwulu, Ilias Goranitis, Adam Devall, Versha Cheed, Ioannis Gallos, Lee Middleton, Hoda Harb, Helen Williams, Abey Eapen, Jane Daniels, A Ahmed, R Bender atik, K Bhatia, C bottomley, Andrew Ewer, Arri Coomarasamy

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Abstract

Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding.

Design: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. Setting: Forty-eight UK NHS early pregnancy units.

Population: Four thousand one hundred and fifty-three women aged 16–39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. Methods: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. Main outcome measures: Cost per additional live birth at ≥34 weeks of gestation.

Results: Progesterone intervention led to an effect difference of 0.022 (95% CI −0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI −£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014–0.096) and this was associated with a cost saving of £322 (95% CI −£1318 to £ 673).

Conclusions: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s).

Tweetable abstract: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.

Original language	English
Pages (from-to)	757-767
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Volume	127
Issue number	6
DOIs	https://doi.org/DOI: 10.1111/1471-0528.16068
Publication status	Published - 31 Jan 2020

Keywords

Health Economics, Progesterone, Miscarriage
miscarriage
progesterone
economic evaluation
Cost-effectiveness

ASJC Scopus subject areas

Obstetrics and Gynaecology

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DOI: 10.1111/1471-0528.16068Licence: Creative Commons: Attribution (CC BY)

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https://doi.org/10.1111/1471-0528.16068Licence: Creative Commons: Attribution (CC BY)

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Aravinthan Coomarasamy
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Roberts, T., Okeke Ogwulu, D., Goranitis, I., Devall, A., Cheed, V., Gallos, I., Middleton, L., Harb, H., Williams, H., Eapen, A., Daniels, J., Ahmed, A., Bender atik, R., Bhatia, K., bottomley, C., Ewer, A., & Coomarasamy, A. (2020). The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial. BJOG: An International Journal of Obstetrics & Gynaecology, 127(6), 757-767. https://doi.org/DOI: 10.1111/1471-0528.16068

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title = "The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial",

abstract = "Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. Design: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. Setting: Forty-eight UK NHS early pregnancy units. Population: Four thousand one hundred and fifty-three women aged 16–39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. Methods: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. Main outcome measures: Cost per additional live birth at ≥34 weeks of gestation. Results: Progesterone intervention led to an effect difference of 0.022 (95% CI −0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI −£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014–0.096) and this was associated with a cost saving of £322 (95% CI −£1318 to £ 673). Conclusions: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). Tweetable abstract: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.",

keywords = "Health Economics, Progesterone, Miscarriage, miscarriage, progesterone, economic evaluation, Cost-effectiveness",

author = "Tracy Roberts and {Okeke Ogwulu}, Duby and Ilias Goranitis and Adam Devall and Versha Cheed and Ioannis Gallos and Lee Middleton and Hoda Harb and Helen Williams and Abey Eapen and Jane Daniels and A Ahmed and {Bender atik}, R and K Bhatia and C bottomley and Andrew Ewer and Arri Coomarasamy",

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Roberts, T , Okeke Ogwulu, D, Goranitis, I, Devall, A , Cheed, V , Gallos, I , Middleton, L , Harb, H, Williams, H, Eapen, A, Daniels, J, Ahmed, A, Bender atik, R, Bhatia, K, bottomley, C, Ewer, A & Coomarasamy, A 2020, 'The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial', BJOG: An International Journal of Obstetrics & Gynaecology, vol. 127, no. 6, pp. 757-767. https://doi.org/DOI: 10.1111/1471-0528.16068

The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial. / Roberts, Tracy ; Okeke Ogwulu, Duby; Goranitis, Ilias et al.
In: BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 127, No. 6, 31.01.2020, p. 757-767.

Research output: Contribution to journal › Article › peer-review

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T2 - an economic evaluation based on the PRISM Trial

AU - Roberts, Tracy

AU - Okeke Ogwulu, Duby

AU - Goranitis, Ilias

AU - Devall, Adam

AU - Cheed, Versha

AU - Gallos, Ioannis

AU - Middleton, Lee

AU - Harb, Hoda

AU - Williams, Helen

AU - Eapen, Abey

AU - Daniels, Jane

AU - Ahmed, A

AU - Bender atik, R

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N2 - Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. Design: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. Setting: Forty-eight UK NHS early pregnancy units. Population: Four thousand one hundred and fifty-three women aged 16–39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. Methods: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. Main outcome measures: Cost per additional live birth at ≥34 weeks of gestation. Results: Progesterone intervention led to an effect difference of 0.022 (95% CI −0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI −£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014–0.096) and this was associated with a cost saving of £322 (95% CI −£1318 to £ 673). Conclusions: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). Tweetable abstract: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.

AB - Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. Design: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. Setting: Forty-eight UK NHS early pregnancy units. Population: Four thousand one hundred and fifty-three women aged 16–39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. Methods: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. Main outcome measures: Cost per additional live birth at ≥34 weeks of gestation. Results: Progesterone intervention led to an effect difference of 0.022 (95% CI −0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI −£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014–0.096) and this was associated with a cost saving of £322 (95% CI −£1318 to £ 673). Conclusions: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). Tweetable abstract: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.

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KW - miscarriage

KW - progesterone

KW - economic evaluation

KW - Cost-effectiveness

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The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM Trial

Abstract

Keywords

ASJC Scopus subject areas

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Website - PRISM

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