CCHE Seminar Series: A retrospective cost-effectiveness analysis of mifepristone-misoprostol medical abortions in the first year at the Regina General Hospital

Biaka Imeah

Saskatchewan Health Authority

Friday February 5th, 2020, 10am-12pm, Zoom

Abstract: Objective: In July 2017, mifepristone–misoprostol (mife/miso) became available for medical abortion at the Regina General Hospital’s Women’s Health Centre (RGH WHC). We investigated whether the proportion of abortions performed medically changed as a result of the introduction of mife/miso, whether using mife/miso instead of the surgical alternative would result in cost savings to the health care system, and whether abortion type differed between patients residing in and outside of Regina. Methods: We conducted a retrospective chart review of all 306 medical abortions from the RGH WHC between July 1, 2017 and June 30, 2018. We obtained medical and surgical abortion information from that year and the preceding one from an administrative database. Statistical methods were used to calculate the costs of mife/miso, methotrexate-misoprostol (MTX/miso) and surgical abortion, as well as cost-effectiveness ratios. Results: The proportion of medical abortions increased from 15.4% in 2016/2017 to 28.7% in 2017/2018 (χ21 =54.629; P < 0.001). Calculated costs for mife/miso, with and without complications were CAN$1173.70 and CAN$1708.90, respectively, versus CAN$871.10 and CAN$1204.10, respectively, for MTX/miso, and CAN$1445.95 and CAN$2261.95, respectively, for hospital-based vacuum aspiration. At a willingness-to-pay threshold of CAN$318 (the cost of mife/miso), statistical modelling showed a 61.3% chance that mife/miso was more cost-effective than surgical abortion and a 90.8% chance that it was more cost-effective than MTX/miso. Patients from Regina were significantly more likely (χ21  =29.406; P < 0.001) to receive a medical abortion (34.9% of abortions) than those living outside of Regina (19.6% of abortions). Conclusion: The proportion of abortions completed medically increased significantly over the period studied. Patients from Regina were more likely to receive medical abortion during both time periods. Mife/miso had a >50% probability of cost-effectiveness over both surgical and MTX/miso options.

Biaka Imeah is a Research Analyst with Saskatchewan Health Authority (SHA). She’s accountable for health services research within Saskatchewan Health Authority.  Before joining SHA, Biaka was an Analyst at the Canadian Center for Health and Safety in Agriculture (CCHSA) and Saskatchewan Liquor and Gaming Authority.  Her research interests include health system performance, healthcare utilization, and economic evaluation of healthcare services and programs. Her past research focused on cost-effectiveness of telehealth in rural Saskatchewan and net benefits of needle-less injectors. Biaka holds a M.A. in economics from the University of Saskatchewan and a B.A. with Honors in economics from the University of Manitoba.