OBJECTIVES: Vacuum aspiration is the current standard for surgical management of early pregnancy loss (EPL). Traditionally performed in a hospital, no reductions in efficacy and safety have been reported for lower-acuity settings. We analyzed how shifting the site of service for surgical management of EPL might impact payer budgets.

METHODS:

A decision tree with a time horizon of 30 days estimated the budget impact of surgical management of EPL performed in different settings: hospital, ambulatory surgical center (ASC), and out-of-hospital office, from the insurance payer perspective. The model included referrals between sites, unplanned follow-up visits, and incomplete procedures always being completed in the hospital setting. The base case assumed that 25% of patients presenting at the ASC or out-of-hospital office were referred to the hospital for treatment. We assessed how the proportion of referrals to the hospital would impact total charges. Model inputs were identified through a structured literature review and costs were taken from the Medicare Physician Fee Schedule and Medicare procedure prices in 2022 USD. Sensitivity analysis included 1,000 Monte Carlo simulations to estimate a 95% credible interval (CrI).

RESULTS: Base case mean total charges were $2,890 [95% CrI 2,885; 2,927] for the hospital, $1,935 [95% CrI 1,904; 1,945] for the ASC, and $1,308 [95% CrI 1,287; 1,328] for out-of-hospital office. When increasing referrals to hospital from 5% to 95%, mean charges ranged from $1,641 to $2,952 (ASC) and $837 to $2,952 (out-of-hospital office). Compared to the hospital charges, total charges were lower for the ASC and out-of-hospital office when referrals were <90%.

CONCLUSIONS: Given the substantial potential decrease in charges for the out-of-hospital office setting, insurance payers might benefit from increasing their reimbursement to encourage more out-of-hospital care while still saving overall and relieving hospitals from performing low-risk procedures.