Costs of alternative treatments for incomplete abortion.

Abstract

A demonstration project was implemented at hospitals in Kenya Mexico and Ecuador between January and August 1991 to identify and explain the factors that contribute to cost differences between the use of dilation and curettage (D&C) and manual vacuum aspiration (MVA) to treat incomplete first-trimester abortion. After an introduction and a brief discussion of methodology the results are presented for duration of hospital stay associated with each procedure for the cost of treating patients for incomplete abortion and for trends in duration of stay and resource utilization. It was found that MVA offers significant potential benefits for women service providers and health care systems and that it requires fewer resources for most of the cost elements studied (staff drugs and hospitalization). The results indicate that realization of the full benefits of MVA depends upon the adoption of changes in patient-management protocols. The discussion continues with a consideration of the policy and protocol decisions required for a change from D&C to MVA including the purchase of MVA instruments training and procedural adaptations (including the adoption of new sterilization procedures and the implementation of appropriate pain control practices) patient-management issues (location of the evacuation procedure in a treatment room rather than an operating room level of priority given to incomplete abortion patients and modifying hospital discharge protocols to eliminate needless waiting time) and decentralization of abortion care to lower levels of the health care system (which is not required but which enhances resource savings and womens health). The outcomes of policy changes related to the treatment of incomplete abortion will be reduced waiting times resource reallocation and improved accessibility of services. These findings have already contributed to policy changes in Kenya Mexico and Ecuador and to discussions with Ministry of Health representatives from Zambia and Zimbabwe. Appendices provide additional information about the study sites explain variations in data collection and describe cost determinants.