{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:15Z","timestamp":1787022135616,"version":"build-2736575974"},"reference-count":15,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and aim<\/jats:title>\n                    <jats:p>Approximately one in four women will experience a miscarriage in their lifetime. Ultrasound-guided manual vacuum aspiration (USG-MVA) is an ideal outpatient surgical treatment alternative to traditional surgical evacuation. We aimed to examine the cost-effectiveness of US-MVA with cervical preparation for treatment of early pregnancy loss from the perspective of public healthcare provider of Hong Kong.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision-analytic model was designed to simulate outcomes in a hypothetical cohort of patients with early pregnancy loss on four interventions: (1) US-MVA, (2) misoprostol, (3) surgical evacuation of uterus by dilation and curettage (surgical evacuation), and (4) expectant care. Model inputs were retrieved from published literature and public data. Model outcome measures were total direct medical cost and disutility-adjusted life-year (DALY). Base-case model results were examined by sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The expected DALYs (0.00141) and total direct medical cost (USD736) of US-MVA were the lowest of all interventions in base-case analysis, and US-MVA was the preferred cost-effective option. One-way sensitivity analysis showed that the misoprostol group became less costly than the US-MVA group if the evacuation rate of misoprostol (base-case value 0.832) exceeded 0.920. In probabilistic sensitivity analysis, At the willingness-to-pay (WTP) threshold of 49630 USD\/DALY averted (1x gross domestic product per capita of Hong Kong), the US-MVA was cost-effective in 72.9% of the time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>US-MVA appeared to be cost-saving and effective for treatment of early pregnancy loss from the perspective of public healthcare provider of Hong Kong.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0294058","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T13:30:19Z","timestamp":1699018219000},"page":"e0294058","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Ultrasound-guided manual vacuum aspiration (USG-MVA) with cervical preparation for early pregnancy loss: A cost-effectiveness analysis"],"prefix":"10.1371","volume":"18","author":[{"given":"Jacqueline Pui-Wah","family":"Chung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4926-0685","authenticated-orcid":true,"given":"Ginenus","family":"Fekadu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daljit Singh","family":"Sahota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tak-Yeung","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5763-7403","authenticated-orcid":true,"given":"Joyce H. S.","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"pone.0294058.ref001","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4471-1918-0_2","article-title":"Spontaneous abortions: epidemiology.","author":"E. Alberman","year":"1992","journal-title":"Spontaneous abortion: diagnosis and treatment"},{"key":"pone.0294058.ref002","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/tog.12198","article-title":"Manual vacuum aspiration: an outpatient alternative for surgical management of miscarriage.","volume":"17","author":"M. Sharma","year":"2015","journal-title":"Obstet Gynaecol"},{"key":"pone.0294058.ref003","first-page":"2021","article-title":"Methods for managing miscarriage: a network meta-analysis.","author":"J Ghosh","year":"2021","journal-title":"Cochrane Database Syst Rev."},{"key":"pone.0294058.ref004","doi-asserted-by":"crossref","first-page":"S539","DOI":"10.1016\/S0020-7292(09)61936-6","article-title":"P444 What for early pregnancy failure manual vacuum aspiration (MVA) with small dose misoprostol or misoprostol alone?","volume":"107","author":"Z. Nasreen","year":"2009","journal-title":"Int J Gynecol Obstet"},{"key":"pone.0294058.ref005","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/ajo.12811","article-title":"Efficacy, feasibility and patient acceptability of ultrasound-guided manual vacuum aspiration for treating early pregnancy loss.","volume":"59","author":"JPW Chung","year":"2019","journal-title":"Aust New Zeal J Obstet Gynaecol"},{"key":"pone.0294058.ref006","doi-asserted-by":"crossref","first-page":"e0262894","DOI":"10.1371\/journal.pone.0262894","article-title":"Economic evaluation of a randomized controlled trial comparing mifepristone and misoprostol with misoprostol alone in the treatment of early pregnancy loss.","volume":"17","author":"CC Hamel","year":"2022","journal-title":"Adang EMM.PLoS One."},{"key":"pone.0294058.ref007","volume-title":"The World health report 2002: Reducing risks, promoting healthy life","author":"World Health Organization","year":"2002"},{"key":"pone.0294058.ref008","author":"Census and Statistics Department","journal-title":"The Government of the Hong Kong SAR. 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