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

Capsule:
Genetic analysis of the products of conception may provide substantial net economic benefits in evaluation of recurrent pregnancy loss.

Authors:
Nastaran Foyouzi, M.D., Marcelle I. Cedars, M.D., Heather G. Huddleston, M.D.
Volume 98, Issue 1 , Pages 151-155.e3, July 2012

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.

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