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Am Fam Physician. 2000;62(2):427

In selected cases, a small unruptured ectopic pregnancy may be treated successfully with methotrexate. Use of single-dose methotrexate has been widely studied, but its success rate varies, leading critics to scrutinize its effectiveness, risk of side effects and associated complications. Morlock and colleagues compared the efficacy and cost-effectiveness of single-dose methotrexate with that of surgical management of ectopic pregnancy.

A MEDLINE search for data from all relevant studies published between 1980 and 1998 was conducted to evaluate outcomes and costs for two first-line therapies for ectopic pregnancy: outpatient, fallopian tube–sparing laparoscopy and up to two doses of methotrexate. Decision-analysis models were constructed to estimate outcomes and costs for each treatment scenario. The primary outcome was resolution of the ectopic pregnancy. Secondary outcomes included complications and side effects, and these were classified as minor, serious or life-threatening. Costs were attributed on the basis of protocols and costs at the authors' institution.

Results from 30 patients were included in the analysis. The rate of resolution for laparoscopy averaged 91 percent, and that for methotrexate averaged 87 percent. Intraoperative and postoperative complications associated with laparoscopy averaged 2 and 9 percent, respectively. Minor complications associated with methotrexate therapy were reported by an average of 10 percent of patients, and serious complications were reported by an average of 7 percent. The cost savings per resolved unruptured ectopic pregnancy was estimated to be more than $3,000 with methotrexate therapy.

The authors conclude that single-dose methotrexate therapy is an effective and cost-saving therapy that preserves fallopian tubes in small, unruptured ectopic pregnancies.

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