European Journal of Obstetrics & Gynecology and Reproductive Biology 88 (2000) 1–6 www.elsevier.com / locate / ejogrb Original Article Direct cost of single dose methotrexate for unruptured ectopic pregnancy Prospective comparison with laparoscopy a,b, a a a a * ´ Fabrice Lecuru , Franc ¸ois Robin , Sophie Chasset , Franck Leonard , Sepideh Guitti , a,b Roland Taurelle a ´ ´ ˆ Service de Gynecologie –Obstetrique, Hopital Boucicaut, 78 rue de la Convention, 75015 Paris, France b ´ ´ Faculte de Medecine Necker—Enfants Malades, 156 rue de Vaugirard, 75730 Paris Cedex 15, France Received 16 January 1999; accepted 21 April 1999 Abstract Objectives: to compare the direct cost of single dose methotrexate (MTX) and laparoscopy in the treatment of unruptured ectopic pregnancy (unruptured EP). Study design: A prospective nonrandomized study. Thirty-two women received intramuscular MTX (1 mg / kg) on an out-patient basis when they fulfilled the following requirements: human chorionic gonadotropin (hCG) level ,5000 IU/l, hematosalpinx diameter ,3 cm and peritoneal fluid ,100 cc. Follow-up consisted of clinical controls and hCG assays. Twenty-seven women eligible for MTX therapy according to the above conditions underwent laparoscopic salpingectomy because some of them refused the therapy while others had contraindications to MTX. We recorded all the medical expenses related to the out-patient and in-patient management for the two treatment options. The cost was calculated according to the French General Nomenclature of Professional Acts and expressed in Euros. Results: MTX resulted in a significantly lower mean direct cost in comparison with surgery (E 1145 vs. 2442, P50.006) that was mainly due to shortened hospital stay (1.1 vs. 2.8 days, P50.007). Conversely MTX required a significantly higher number of medical acts during the follow-up. Costs for MTX therapy were closely related to the length of hospitalization and to the duration of the follow-up. Conclusion: Single dose MTX provides significant cost-savings when compared to laparoscopy. Savings reach a peak for small unruptured EP because hospitalization is not required and the length of follow-up reduced.  2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Cost; Ectopic pregnancy; Laparoscopy; Methotrexate; Prospective study 1. Introduction estimated cost of more than $US 1 billion in the USA in 1990 [3]. Ectopic pregnancy (EP) still remains a major cause of For a long time, surgery was the only treatment. But morbidity and the first cause of mortality during the first after the pioneering description by Tanaka et al. [4], trimester of pregnancy [1]. Its prevalence was as high as several authors have reported the interest of methotrexate 1.97% of reported pregnancies in 1992 in the USA, and (MTX) in the management of unruptured EP (unruptured 1.58% of reported pregnancies in 1994 in France [2]. This EP). Today some reports make evidence that, in selected results in a high consumption of health resources, with an cases, MTX is as effective as surgery. Two randomized trials demonstrated that tubal injections provided the same success rate than laparoscopic salpingostomy [5,6]. Re- cently, a randomized series reported that intramuscular (IM) injections of MTX and laparoscopy give equivalent *Corresponding author. Tel.: 133-1-5378-8137; fax: 133-1-5378- cure rates [7]. 8137. E-mail address: fabrice.lecuru@bcc.ap-hop-paris.fr (F. Lecuru) Single dose IM MTX, which is the simplest and least 0301-2115 / 00 / $ – see front matter  2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S0301-2115(99)00125-6