부산대학교 도서관

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1471-0528.2009.02142.x Byline: D Hu (a), D Grossman (b), C Levin (c), K Blanchard (d), SJ Goldie (a) Keywords: Abortion; cost-effectiveness analysis Abstract: Objective To assess the comparative health and economic outcomes associated with three alternative first-trimester abortion techniques in Mexico City and to examine the policy implications of increasing access to safe abortion modalities within a restrictive setting. Design Cost-effectiveness analysis. Setting Mexico City. Population Reproductive-aged women with unintended pregnancy seeking first-trimester abortion. Methods Synthesising the best available data, a computer-based model simulates induced abortion and its potential complications and is used to assess the cost-effectiveness of alternative safe modalities for first-trimester pregnancy termination: (1) hospital-based dilatation and curettage (D&C), (2) hospital-based manual vacuum aspiration (MVA), (3) clinic-based MVA and (4) medical abortion using vaginal misoprostol. Main outcome measures Number of complications, lifetime costs, life expectancy, quality-adjusted life expectancy. Results In comparison to the magnitude of health gains associated with all safe abortion modalities, the relative differences between strategies were more pronounced in terms of their economic costs. Assuming all options were equally available, clinic-based MVA was the least costly and most effective. Medical abortion with misoprostol provided comparable benefits to D&C, but cost substantially less. Enhanced access to safe abortion was always more influential than shifting between safe abortion modalities. Conclusions This study demonstrates that the provision of safe abortion is cost-effective and will result in reduced complications, decreased mortality and substantial cost savings compared with unsafe abortion. In Mexico City, shifting from a practice of hospital-based D&C to clinic-based MVA and enhancing access to medical abortion will have the best chance to minimise abortion-related morbidity and mortality. Author Affiliation: (a)Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA (b)Ibis Reproductive Health, c/o Department of Obstetrics and Gynecology, San Francisco General Hospital, San Francisco, CA, USA (c)Program for Appropriate Technology in Health (PATH), Seattle, WA, USA (d)Ibis Reproductive Health, Cambridge, MA, USA Article History: Accepted 27 January 2009. Article note: Delphine Hu, MD, MPH, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 2nd floor, Boston, MA 02115, USA. Email: freeflap@gmail.com