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Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis

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  • Susanne Sjöström
  • Helena Kopp Kallner
  • Emilia Simeonova
  • Andreas Madestam
  • Kristina Gemzell-Danielsson

Abstract

Objective: The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. Study design: A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. Results: The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Conclusion: Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women’s access to safe abortion.

Suggested Citation

  • Susanne Sjöström & Helena Kopp Kallner & Emilia Simeonova & Andreas Madestam & Kristina Gemzell-Danielsson, 2016. "Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-9, June.
    • Handle: RePEc:plo:pone00:0158645
    DOI: 10.1371/journal.pone.0158645
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    References listed on IDEAS

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    1. Weitz, T.A. & Taylor, D. & Desai, S. & Upadhyay, U.D. & Waldman, J. & Battistelli, M.F. & Drey, E.A., 2013. "Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver," American Journal of Public Health, American Public Health Association, vol. 103(3), pages 454-461.
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    Cited by:

    1. Samantha R Lattof & Ernestina Coast & Yana van der Meulen Rodgers & Brittany Moore & Cheri Poss, 2020. "The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-25, November.

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