OBJECTIVES:

Miscarriage has a huge impact on the wellbeing of individuals and on the cost to society and health payers especially in middle income countries. The aim of this study is to assess the cost-comparison of dydrogesterone with oral micronized progesterone in preventing pregnancy loss in women with early pregnancy vaginal bleeding in three middle income countries (Brazil, Mexico and Egypt).

METHODS:

Two systematic reviews were used to identify the relevant literature comparing the efficacy of miscarriage rates and live birth rates post treatment. Meta-analysis and indirect treatment comparisons were conducted to determine the comparative effectiveness of the two drugs. The population cohort was based on the number of women pregnant with a risk of threatened miscarriage in each of the six countries.

A cost comparison analysis was performed from a healthcare payer and societal perspective using costs of treatment and expected productivity losses based on daily wages. The main outcomes were cost per miscarriage avoided, and cost per additional live birth at ≥34 weeks of gestation.

RESULTS:

Oral dydrogesterone was the dominant strategy in the three countries with a total saving of between $8 million and $31 million (Brazil $31 million; Egypt - $8 million; Mexico - $9 million) and a healthcare payer saving of between $3.8 million and $24 million (Brazil $24 million; Egypt - $3.8 million; Mexico - $4.7 million). Oral dydrogesterone demonstrated a cost saving of between $21 and $42 per treated woman.

CONCLUSIONS:

The results suggest that oral dydrogesterone is a cost saving intervention for women at risk of miscarriage with early pregnancy vaginal bleeding.