Is chromosome testing of the second miscarriage cost saving? A decision analysis of selective versus universal recurrent pregnancy loss evaluation

Lia A. Bernardi, Beth A. Plunkett, Mary D. Stephenson*

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)156-161
Number of pages6
JournalFertility and Sterility
Volume98
Issue number1
DOIs
StatePublished - Jul 1 2012

Keywords

  • Recurrent pregnancy loss
  • chromosome testing
  • cost analysis
  • decision analysis
  • recurrent miscarriage

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

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