{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:54:56Z","timestamp":1785887696440,"version":"3.56.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T00:00:00Z","timestamp":1713139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of the present study was to compare accuracy, safety and cost\u2010effectiveness of three \u03b2\u2010hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 \u03b2\u2010hCG levels, (2) day 1 to 4 \u03b2\u2010hCG levels and (3) day 4 to 7 \u03b2\u2010hCG levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cost\u2010minimization analysis (CMA) based on a retrospective study of patients treated with single\u2010dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in \u03b2\u2010hCG levels with sensitivity, specificity and PPV of 76.6% (69.9\u201382.5, 95% CI), 75.5% (60.5\u201387.1, 95% CI) and 92.8% (88.4\u201395.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20\u2009years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients treated with MTX for EP, measurement of day 1 and day 7 \u03b2\u2010hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.15511","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T14:24:50Z","timestamp":1713191090000},"page":"1330-1336","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pharmacological treatment of ectopic pregnancy: Accuracy, safety and cost\u2010effectiveness of day 1\u20137 <scp>\u03b2\u2010hCG<\/scp> measurements"],"prefix":"10.1002","volume":"166","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4211-9526","authenticated-orcid":false,"given":"Adi","family":"Dayan\u2010Schwartz","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"},{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan","family":"Abd\u00a0Elgani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamam","family":"Abdul\u2010Ghani","sequence":"additional","affiliation":[{"name":"Department of Human Biology University of Haifa  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liron","family":"Kogan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Reiss","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"},{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Tal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"},{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0301-2115(99)00125-6"},{"key":"e_1_2_10_3_1","first-page":"754","article-title":"Single\u2010dose methotrexate for treatment of ectopic pregnancy","volume":"77","author":"Stovall TG","year":"1991","journal-title":"Obstet Gynecol"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(93)90687-E"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12257"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2017.07.025"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4527-1"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2019.1575344"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.17219\/acem\/153043"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002464"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0029-7844(99)00548-7"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00037.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2021.151488"},{"key":"e_1_2_10_14_1","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond MF","year":"2015"},{"key":"e_1_2_10_15_1","unstructured":"\u05d4\u05e9\u05db\u05e8 \u05d4\u05de\u05de\u05d5\u05e6\u05e2 \u05d1\u05e8\u05d5\u05d8\u05d5 \u05dc\u05de\u05e9\u05e8\u05ea \u05e9\u05db\u05d9\u05e8 \u05e9\u05dc \u05e2\u05d5\u05d1\u05d3\u05d9\u05dd \u05d9\u05e9\u05e8\u05d0\u05dc\u05d9\u05dd \u05d1\u05e9\u05e0\u05ea.2020. 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