Cost-utility Analysis of Outpatient Manual Vacuum Aspiration Versus Operating Room Electric Aspiration for the Management of First-trimester Miscarriage (ASPIR)

July 27, 2026 updated by: Nantes University Hospital

Cost-utility Analysis of Outpatient Manual Vacuum Aspiration Versus Operating Room Electric Aspiration for the Management of First-trimester Miscarriage (ASPIR Study)

The ASPIR study aims to evaluate the cost-utility of outpatient manual vacuum aspiration compared with operating room electric aspiration for the management of first-trimester miscarriage. It is hypothesized that manual aspiration will demonstrate equivalent clinical efficacy and patient quality of life while reducing healthcare costs.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Miscarriage occurs in approximately 15% of pregnancies during the first trimester. In France, surgical management usually involves electric aspiration in the operating room under anesthesia, associated with hospital admission. Manual vacuum aspiration (MVA) is widely used in low-resource settings and for induced abortion, with demonstrated safety and patient satisfaction. This multicenter randomized controlled trial compares outpatient MVA under local anesthesia and inhaled analgesia versus electric aspiration (EA) under anesthesia in the operating room.

The primary objective is to assess the incremental cost-utility ratio (ICUR, cost per QALY) at 3 months. Secondary outcomes include complications, pain, satisfaction, quality of life, and fertility at 12 months. The study anticipates enrolling 860 participants across multiple centers in France.

Study Type

Interventional

Enrollment (Estimated)

860

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Female, aged 18-44 years
  • Ultrasound-confirmed first-trimester miscarriage requiring surgical management
  • Gestational age between 5 and 12 weeks of amenorrhea
  • Incomplete spontaneous abortion or ongoing non-viable pregnancy
  • Patient able to provide oral informed consent

Exclusion Criteria:

  • Complete expulsion of pregnancy (endometrial thickness < 15 mm)
  • Choice of medical treatment with misoprostol
  • Elective termination of pregnancy
  • Unwanted pregnancy
  • Pregnancy of unknown location, molar pregnancy
  • Known uterine malformation
  • Prior surgical aspiration for the current pregnancy
  • Intrauterine device in place
  • Contraindicating medications (e.g. anticoagulants)
  • Protected adults (under guardianship)
  • Inability to complete study questionnaires
  • Lack of social security coverage
  • Haemorrhagic miscarriage

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Manual vacuum aspiration (MVA)
Outpatient manual vacuum aspiration under local anesthesia and inhaled analgesia (MEOPA).
Procedure: Manual vacuum aspiration (MVA)
Performed in consultation under local anesthesia and inhaled analgesia, using a manual vacuum aspirator and appropriate cannula. Post-procedure pelvic ultrasound to confirm complete evacuation.
Active Comparator: Electric aspiration in the operating room under general or regional anesthesia. Electric aspiration
Electric aspiration in the operating room under general or regional anesthesia. Performed in the operating room under general or regional anesthesia, using an electric suction device and appropriate cannula. Post-procedure pelvic ultrasound to confirm complete evacuation.
Procedure: Electric aspiration (EA)
Performed in the operating room under general or regional anesthesia, using an electric suction device and appropriate cannula. Post-procedure pelvic ultrasound to confirm complete evacuation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incremental cost-utility ratio (ICUR)
Time Frame: 3 months
Incremental cost per quality-adjusted life year (QALY) gained of outpatient MVA compared to operating room EA, from a collective perspective.
3 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Annual net financial benefit for health insurance over up to 5 years of different development scenarios for manual vacuum aspiration in consultation for the management of pregnancies terminated before 12 weeks of gestation
Time Frame: up to 5 years
Annual net financial benefit for health insurance over up to 5 years of different development scenarios for manual vacuum aspiration in consultation for the management of pregnancies terminated before 12 weeks of gestation
up to 5 years
To compare the two management strategies in terms of success and intraoperative and postoperative complications
Time Frame: 1 month

To compare the two management strategies in terms of success and intraoperative and postoperative complications

  • 2.1 Management failure defined by the need for second-line treatment (aspiration, misoprostol, etc.)
  • 2.2 Intraoperative complications: change of strategy, bleeding greater than 200 ml, uterine perforation, etc., and all possible complications classified according to the Clavien and Dindo criteria
  • 2.3 Trophoblastic retention image defined by retention (heterogeneous intrauterine mass independent of the endometrium) greater than 20 mm thick on transvaginal ultrasound at M1.
1 month
To assess patient satisfaction
Time Frame: day 1 and 2

To assess patient satisfaction:

A numerical scale (NS) (0-10) on Days 1 and 2.
day 1 and 2
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: days 0, 1,7 and 1 and 3 months

To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:

●Pain via NS (a scale from 0 to 10) on Day 0 (before the procedure, 30 min after the procedure +/- 30 min), Days 1, 7, 1, and 3
days 0, 1,7 and 1 and 3 months
The risk factors for failure
Time Frame: 3 months
The risk factors for failure at M3 studied will be: the term of the terminated pregnancy, patient compliance, patient satisfaction (numerical scale (from 0 to 10), patient characteristics (age).
3 months
Satisfaction with the patient's care by medical staff
Time Frame: day 0 and 1 month
Satisfaction with the patient's care by medical staff will be assessed using an EN (numerical scale 0 to 10) at D0 and M1
day 0 and 1 month
Patient having been pregnant in days
Time Frame: 12 months
Patient having been pregnant at 12 months, pregnancy outcome and time to conception in days.
12 months
To assess patient satisfaction
Time Frame: day 1 and 2 and 1 month et 3 month

To assess patient satisfaction:

A numerical scale (NS) (0-10) on Days 1 and 2. HADS (Hospital Anxiety and Depression Scale) and PCL-5 questionnaires at 1 and 3 months
day 1 and 2 and 1 month et 3 month
To assess patient satisfaction
Time Frame: 1 and 3 months
HADS (Hospital Anxiety and Depression Scale) and PCL-5 questionnaires at 1 and 3 months
1 and 3 months
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: Day 0, 1,7 and 1 and 3 months

To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:

●Pain via NS (a scale from 0 to 10) on Day 0 (before the procedure, 30 min after the procedure +/- 30 min), Days 1, 7, 1, and 3
Day 0, 1,7 and 1 and 3 months
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: Day 0 to 7

To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:

●Analgesic consumption (type, quantity, and duration) from Day 0 to 7
Day 0 to 7
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: Day 0 to 7

To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:

●Number of pads used per day (Higham score) from Days 1 to 7
Day 0 to 7
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: Day 0

To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:

  • Duration of the procedure in minutes
  • Waiting time for therapeutic treatment in minutes
  • Time spent in hospital in minutes
Day 0
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: 1 and 3 months

To compare the two strategies (electric suction versus manual vacuum kit suction)

● Postoperative complications will include:Perioperative bleeding greater than 200 ml (Higham score), infection (temperature >38°C and pelvic symptoms) …classified according to the Calvien and Dindo criteria, at M1, the persistence of abnormal bleeding, trophoblastic retention, at M3, the presence of amenorrhea outside the context of a new pregnancy
1 and 3 months
To compare the two strategies (electric suction versus manual vacuum kit suction)
Time Frame: 1 et 3 months

To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:

●quality of life questionnaires EQ-5D-5L, PGI-I at M1 and M3
1 et 3 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Nantes University Hospital

Investigators

  • Principal Investigator: Thibault Thubert, Pr, Nantes University Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 1, 2026

Primary Completion (Estimated)

January 1, 2027

Study Completion (Estimated)

October 1, 2029

Study Registration Dates

First Submitted

May 28, 2026

First Submitted That Met QC Criteria

July 27, 2026

First Posted (Actual)

July 28, 2026

Study Record Updates

Last Update Posted (Actual)

July 28, 2026

Last Update Submitted That Met QC Criteria

July 27, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • RC24_0471
  • 2025-A00724-45 (Other Identifier: ANSM)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Individual participant data may be shared upon reasonable request, subject to sponsor approval and compliance with French/EU data protection regulations (GDPR).

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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