Procedural management of early pregnancy loss in different hospital settings: a cost-consequence analysis for the USA
Bibliographic record
Abstract
Background: Procedural management is one option for the management of early pregnancy loss (EPL). It is a highly effective procedure that is usually performed in the operating room (OR) using a vacuum aspirator. Lower acuity settings have been shown to be equally safe and effective for low-risk patients. This health-economic analysis was developed to estimate hospital costs and clinical consequences when changing the site of service for procedural treatment from the OR to the emergency room (ER) or an in-facility office. Methods: A cost-consequence model was developed for a US hospital setting. The model population included hypothetical, low-risk patients who chose procedural management for EPL. The patient care pathway was modeled with a decision tree. Patients received treatment either in a lower acuity setting (ER or in-facility office) using a manual vacuum aspirator or in the OR using an electric vacuum aspirator. Model inputs were sourced based on a structured literature review of PubMed articles. Probabilistic and one-way sensitivity analyses were performed to assess the robustness of results. Results: The model estimated mean per-patient cost savings of $1,656 [95% credible interval (CrI): $1,555 to $1,735] for the ER and $1,698 (95% CrI: $1,647 to $1,839) for the in-facility office compared with the OR. The time from diagnosis to completion was reduced by 4.66 days for the ER and 3.33 days for the in-facility office. Hospital-resource time was decreased by 218 minutes in the ER and 231 minutes in the in-facility office. The time the patient spent waiting in hospital was increased by 57 minutes in the ER and decreased by 66 minutes in the in-facility office in comparison to the OR. Conclusions: The logistical and administrative burden of extending sites of service may be rewarded by substantial cost savings and more flexibility when offering procedural management for EPL.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.006 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".