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

27. juli 2026 opdateret af: 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.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

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.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

860

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

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

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Sundhedstjenesteforskning
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Manual vacuum aspiration (MVA)
Outpatient manual vacuum aspiration under local anesthesia and inhaled analgesia (MEOPA).
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.
Aktiv komparator: 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.
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.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incremental cost-utility ratio (ICUR)
Tidsramme: 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

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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)
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 12 months
Patient having been pregnant at 12 months, pregnancy outcome and time to conception in days.
12 months
To assess patient satisfaction
Tidsramme: 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
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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)
Tidsramme: 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

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Ledende efterforsker: Thibault Thubert, Pr, Nantes university hospital

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

1. oktober 2026

Primær færdiggørelse (Anslået)

1. januar 2027

Studieafslutning (Anslået)

1. oktober 2029

Datoer for studieregistrering

Først indsendt

28. maj 2026

Først indsendt, der opfyldte QC-kriterier

27. juli 2026

Først opslået (Faktiske)

28. juli 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

28. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

27. juli 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • RC24_0471
  • 2025-A00724-45 (Anden identifikator: ANSM)

Plan for individuelle deltagerdata (IPD)

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IPD-planbeskrivelse

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

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