The cost-effectiveness of introducing manual vacuum aspiration compared with dilatation and curettage for incomplete first-trimester miscarriages at a tertiary hospital in Manzini, Swaziland

Abstract

BACKGROUND. Despite the proven efficacy of manual vacuum aspiration (MVA) for incomplete miscarriages its use is low in Swaziland, including Raleigh Fitkin Memorial (RFM) Hospital, Manzini. Uncertainty about the cost implications of introducing MVA to replace dilatation and curettage (D&C) is probably the major obstacle to change. OBJECTIVES. To evaluate the cost-effectiveness of introducing MVA as an evacuation method for first-trimester incomplete miscarriages, as well as assess the implications of the introduction of MVA for the entire post-miscarriage care budget at RFM Hospital. METHODS. The methods comprised cost-effectiveness and budget-impact analyses from a healthcare perspective based on a theoretical cohort. Clinical outcomes data for procedures were obtained from the relevant literature. Costs were collated from prospective suppliers and then compared for the two treatment modalities. Future numbers of annual evacuations were extrapolated from previous annual figures. First-trimester miscarriages were in turn extrapolated from proportions found in previous studies. Total budgets were calculated under the current scenario, and for scenarios where MVA was introduced. RESULTS. With initial capital costs of ZAR11 093.00, introduction of MVA for first-trimester incomplete abortions would cut postmiscarriage care costs by 34.7%. MVA would cost ZAR819.86 per procedure, while D&C costs ZAR1 255.40 per procedure. An estimated 26 MVA procedures done instead of D&Cs would compensate for the initial capital investment. Introduction of MVA into the postmiscarriage care programme would save the hospital about ZAR516 115.30 annually, with clinical outcomes at least similar to D&C. CONCLUSIONS. MVA should be considered as the first option in first-trimester post-miscarriage care.