Is chromosome testing of the second miscarriage cost- saving: A decision analysis of selective vs. universal recurrent pregnancy loss evaluation

Selective recurrent pregnancy loss (RPL) evaluation, which is based upon chromosome testing of the second miscarriage, is a cost-saving strategy for couples with RPL when compared with universal RPL evaluation.

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Authors

Lia A. Bernardi, M.D., Beth A. Plunkett, M.D., M.P.H., Mary D. Stephenson, M.D., M.Sc.

Vol 98, Issue 1 , Pages 156-161

Abstract

Objective:

To compare the cost of selective recurrent pregnancy loss (RPL) evaluation, which is defined as RPL evaluation if the second miscarriage is euploid, versus universal RPL evaluation, which is defined as RPL evaluation after the second miscarriage. Traditionally, an RPL evaluation is instituted after the third miscarriage. However, recent studies suggest evaluation after the second miscarriage, which dramatically increases health care costs. Alternatively, chromosome testing of the second miscarriage, to determine whether an RPL evaluation is required, has been proposed.

Design:

Decision-analytic model.

Setting:

Academic medical center.

Patient(s):

Couples experiencing a second miscarriage of less than 10 weeks size.

Intervention(s):

Selective versus universal RPL evaluation after the second miscarriage.

Main Outcome Measure(s):

Estimated cost for selective versus universal RPL evaluation.

Result(s):

The estimated cost of selective RPL evaluation after the second miscarriage was $3,352, versus $4,507 for universal RPL evaluation, resulting in a cost savings of $1,155. With stratification by maternal age groups, selective RPL evaluation resulted in increased cost savings with advancing maternal age groups.

Conclusion(s):

Selective RPL evaluation, which is based upon chromosome testing of the second miscarriage, is a cost-saving strategy for couples with RPL when compared with universal RPL evaluation. With advancing maternal age groups, the cost savings increased.

Read the full text at: http://www.fertstert.org/article/S0015-0282(12)00376-7/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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