Cost of Treatment of Ectopic Pregnancy: Single-Dose Methotrexate Versus Surgical Treatment

Abstract

This study compared the immediate direct medical expenses for medical and surgical approaches to ectopic pregnancy treatment using a retrospective review from a university-based teaching facility of 60 consecutive patients in an urban setting who were treated for ectopic pregnancy.

One of the three treatment modalities was used: single-dose methotrexate (N = 21; 35%), laparoscopy (N = 15; 25%), or laparotomy (N = 24; 40%). Direct health care expenses were obtained directly from the hospital's financial system. The mean direct cost of methotrexate treatment ($1,563; range $1,169 to $2,300), was significantly lower than either laparoscopic treatment ($6,626; range $5,683 to $10,429; p < 0.00001) or laparotomy ($8,001; range $6,834 to $22,082; p < 0.00001). The differences in charges among medically managed patients were due primarily to the varying length of outpatient follow-up required. No patients in this analysis failed to respond to medical therapy or had notable side effects, and no patient in the surgical groups experienced persistent trophoblastic growth. The length of hospital stay in the laparoscopy group ranged from 1 to 7 days (mean 2.5 days), with one patient experiencing a major postoperative complication. Patients requiring laparotomy had higher hospital expenses, with seven patients having charges in excess of $10,000, all of whom had one or more postoperative complications. The length of hospital stay ranged from 2 to 18 days, with an average of 5.2 days.

Single-dose methotrexate treatment can be an effective health care cost-containing therapy that achieves an efficacious clinical outcome. Since 45% of patients with ectopic pregnancy are eligible for methotrexate, expenses for treatment of this condition could be reduced by 27%, if all other variables remain equal.