OBJECTIVES: The aim of this study was to conduct an economic analysis comparing costs and outcomes of treating patients with dydrogesterone or progesterone for threatened miscarriage and habitual miscarriage indications in China. METHODS: An economic analysis was conducted to compare costs and outcomes of current clinical practice in China for the above mentioned two indications. Population and treatment data were derived from an evidence review of published literature. Local cost data were determined from a healthcare perspective, using data of Shanghai Patient Electronic Medical Records and key opinion leader response. Data were analyzed to obtain outcomes, costs and incremental average cost of therapy in relation to outcome achieved. RESULTS: For the treatment of threatened and habitual miscarriage, there was a miscarriage rate of 8.2% and 8% with dydrogesterone and 9.8% and 15.7% with micronized vaginal progesterone respectively. For threatened miscarriage, the economic burden for each miscarriage avoided is calculated at RMB 36,896 (US$4,579), which lies below the expected willingness to pay ratio (1 time GDP/capita). Treatment of habitual miscarriage with dydrogesterone versus micronized vaginal progesterone is calculated to be cost-saving, as the incremental cost-effectiveness ratio for using dydrogesterone results in savings of RMB 5,261 ($895) per miscarriage avoided. CONCLUSIONS: Dydrogesterone represents great economic value when compared to micronized vaginal progesterone for the public payer in China, as it proves to be a cost-effective option for threatened miscarriage and a cost-saving option for the treatment of habitual miscarriage. In addition, a reduction of miscarriages reduces indirect costs associated with post-miscarriage care, workforce absenteeism and loss of productivity.