Cost-analysis of Misoprostol and Mifepristone versus Misoprostol and Methotrexate when used for medical termination of pregnancy in women of gestational age of 7 weeks and less at Embhuleni Hospital in Elukwatini, Mpumalanga.

Abstract

Background: The purpose of the Republic of South Africa Choice on Termination of Pregnancy Act 92 of 1996 is to provide a safe and effective alternative to the rife illegal abortions taking place in South Africa. The Department of Health’s standard treatment guidelines recommend a regimen of 200mg Mifepristone orally stat followed by 800mcg of Misoprostol sublingually after 24 to 48 hours (for up to 9 weeks or 63 days gestation) for termination pregnancy. Mifepristone has a relatively high cost and cost-effective alternatives would be beneficial to alleviate the strain on the National Healthcare budget caused by the official termination of pregnancy regimen. Aim: To perform a budget impact analysis and calculate potential savings if Methotrexate/Misoprostol combination is used for termination of pregnancy in women of gestational age less than or equal to 7 weeks compared to the current regimen of Mifepristone/misoprostol Setting: This study was undertaken at Embhuleni hospital, a 220-bed district hospital located in the Chief Albert Luthuli sub-district in Mpumalanga. Method: Three hundred and twelve (n=312) medical records of patients who visited the Choice of Termination of Pregnancy clinic during the 2017/2018 financial year, were retrieved and analyzed. Only medical termination of pregnancy medicines cost was considered. The total cost for the medicine (Misoprostol and Mifepristone) used to bring about an abortion was calculated using the information gathered from personal details and treatment regimen. Tender prices for 2017 were used for the medicines on national tender. Results: The current regimen of misoprostol/mifepristone costs R289.25 per case. The total cost incurred by the hospital in the 2017/2018 financial year for this medicine regimen was R90, 246.00 for a total of 312 patients. The proposed regimen comprising of methotrexate tablets and misoprostol costs R32.50 per patient whilst the total cost of using methotrexate injection and misoprostol tablets is R61.61 per patient. The current regimen impacted the medicine budget by 0.95% (0.51% if used for women of gestational age 7 weeks or less), 0.05% using the Methotrexate (MXT) tablets and 0.11% using the MXT injection. The alternative regimens were still cost-saving when tested through a sensitivity analysis. Conclusion: Both MXT injection and tablets are registered in South Africa and have local manufacturers and distributors. Currently in the public sector, Mpumalanga Department of Health formulary, the MXT 2.5mg tablets are on tender. If MTX tablets had been used, the total cost savings would have been 48% and 43% for the injection. In order to bring about change which will recommend for the indications of MXT to include Medical termination of pregnancy. More studies need to be done across the country to determine the overall financial impact the current regimen has and how much money could be saved from amending the guidelines to include the cost-effective regimen of MXT and misoprostol in combination. This study was not without limitations, it studied only the medicine required to bring about an abortion, for a more comprehensive budget impact analysis more variables will need to be considered.