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.
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Date
2019
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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.
Description
Masters Degree. University of KwaZulu-Natal, Durban.