Cost-utility Analysis of Outpatient Manual Vacuum Aspiration Versus Operating Room Electric Aspiration for the Management of First-trimester Miscarriage (ASPIR)
Cost-utility Analysis of Outpatient Manual Vacuum Aspiration Versus Operating Room Electric Aspiration for the Management of First-trimester Miscarriage (ASPIR Study)
Studieoversikt
Status
Intervensjon / Behandling
Detaljert 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.
Studietype
Registrering (Antatt)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
- Navn: Thibault Thubert, Pr
- Telefonnummer: +33253482443
- E-post: thibault.thubert@chu-nantes.fr
Studiesteder
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Nantes, Frankrike, 44000
- CHU de Nantes
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Ta kontakt med:
- Thibault Thubert, Pr
- Telefonnummer: +33 2 53 48 24 43
- E-post: thibault.thubert@chu-nantes.fr
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
Tar imot friske frivillige
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
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Helsetjenesteforskning
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Eksperimentell: Manual vacuum aspiration (MVA)
Outpatient manual vacuum aspiration under local anesthesia and inhaled analgesia (MEOPA).
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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.
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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.
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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.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Incremental cost-utility ratio (ICUR)
Tidsramme: 3 months
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Incremental cost per quality-adjusted life year (QALY) gained of outpatient MVA compared to operating room EA, from a collective perspective.
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3 months
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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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
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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
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up to 5 years
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To compare the two management strategies in terms of success and intraoperative and postoperative complications
Tidsramme: 1 month
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To compare the two management strategies in terms of success and intraoperative and postoperative complications
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1 month
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To assess patient satisfaction
Tidsramme: day 1 and 2
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To assess patient satisfaction: A numerical scale (NS) (0-10) on Days 1 and 2. |
day 1 and 2
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: days 0, 1,7 and 1 and 3 months
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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
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The risk factors for failure
Tidsramme: 3 months
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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).
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3 months
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Satisfaction with the patient's care by medical staff
Tidsramme: day 0 and 1 month
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Satisfaction with the patient's care by medical staff will be assessed using an EN (numerical scale 0 to 10) at D0 and M1
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day 0 and 1 month
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Patient having been pregnant in days
Tidsramme: 12 months
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Patient having been pregnant at 12 months, pregnancy outcome and time to conception in days.
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12 months
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To assess patient satisfaction
Tidsramme: day 1 and 2 and 1 month et 3 month
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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
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To assess patient satisfaction
Tidsramme: 1 and 3 months
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HADS (Hospital Anxiety and Depression Scale) and PCL-5 questionnaires at 1 and 3 months
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1 and 3 months
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: Day 0, 1,7 and 1 and 3 months
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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
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: Day 0 to 7
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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
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: Day 0 to 7
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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
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: Day 0
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To compare the two strategies (electric suction versus manual vacuum kit suction), measurement of:
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Day 0
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: 1 and 3 months
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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
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To compare the two strategies (electric suction versus manual vacuum kit suction)
Tidsramme: 1 et 3 months
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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
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Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Thibault Thubert, Pr, Nantes university hospital
Studierekorddatoer
Studer hoveddatoer
Studiestart (Antatt)
Primær fullføring (Antatt)
Studiet fullført (Antatt)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- RC24_0471
- 2025-A00724-45 (Annen identifikator: ANSM)
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