A new drug combination that is better at treating ‘silent’ miscarriages than the currently used NHS treatment is more cost-effective, according to a new study.
An estimated 23 million miscarriages occur every year worldwide – equating to 44 pregnancy losses each minute. In the UK, miscarriages cost more than £1bn per year due to impact on the NHS, lost productivity, and long-term physical and mental health impacts.
Carried out by the University of Birmingham and Tommy’s National Centre for Miscarriage Research, the study, funded by National Institute for Health Research (NIHR), found that the combined drug is more effective than the standard medication for women having miscarriages without symptoms, known as missed, delayed, or silent miscarriage.
These miscarriages occur when a foetus has died in the womb, but the mother has not had any symptoms. Current hospital restrictions on surgery due to COVID-19 mean that many women face waiting for the miscarriage to happen by itself or are offered medication to speed the process along.
This is the largest ever study into the most effective medical treatment for missed miscarriage, and based on the findings, the researchers and campaigners are calling for new guidance from the National Institute for Health and Care Excellence (NICE).
The study has been published in the British Journal of Obstetrics and Gynaecology.
An improvement on current treatment
Currently, a treatment called misoprostol is recommended, however in some cases it is not successful, and surgery is needed instead.
Former research that had been published in The Lancet in 2020 demonstrated misoprostol as more effective when combined with mifepristone, an anti-progesterone drug used to induce labour.
The trial found that the combined drug treatment worked in 83% of cases, compared to 76% in the misoprostol and placebo group – reducing the need for surgery. One in four women (25%) given the placebo later needed an operation to complete the miscarriage, compared with less than one in five (18%) of those who had the new medication.
The research team has now assessed the cost-effectiveness of mifepristone and misoprostol combined, finding that the new combined drug treatment was on average £182 cheaper for each successfully managed miscarriage than the current standard NHS medication.
Senior author Tracy Roberts, Professor of Health Economics at the University of Birmingham, said: “Pregnancy loss causes heartbreak for millions of families, and it is crucial that we find better ways to care for everyone going through miscarriage. Our findings could have huge benefits if they’re translated into clinical practice, with better outcomes for patients and lower costs for care services.”
First author Dr Duby Okeke Ogwulu, of the University of Birmingham’s Institute of Applied Health Research, added: “We hope the NICE guidance will be updated in light of this new evidence, so that everyone who needs it has access to the most effective treatment.”
Tommy’s CEO Jane Brewin commented: “Besides the physical harm, miscarriage can have serious psychological consequences, which can be made worse by the trauma of a failed treatment forcing mothers to endure weeks of carrying a baby they know has died.
“One in four pregnancies ends in loss, and while our researchers work to understand how we can prevent this, it’s vital their latest findings are put into practice so that everyone going through miscarriage has the best possible care. Particularly given COVID-19 pressures on the NHS, our new study could be applied to make better use of precious resources, as well as reducing the toll miscarriage can take on parents.”