RETROSPECTIVE AND SINGLECENTER STUDY WITH THE AIM OF PHARMAECONOMIC ANALYSIS IN PREGNANCY TERMINATIONS AT SAN GIULIANO HOSPITAL OF ASL NAPOLI 2 NORD.

Abstract

Introduction:
Pregnancy termination (IG) is a widely practiced clinical procedure and can be therapeutic (IGT), pharmacological (IGF), or surgical (IGS). The analysis of total costs associated with different methods is useful to highlight advantages and disadvantages for the patient and to enable decision-makers to intervene in a precise manner on company policies supported by concrete data. The relevant legislation governing pregnancy termination is Law 194/78, with specific reference to voluntary termination, permitted within the first 90 days of gestation. This deadline can only be exceeded in special cases, such as severe risk to the mother or fetal malformation. The Law 194/78 aims to ensure that the process of voluntary termination (IVG) is guaranteed, and in this sense, family planning clinics serve as a reference service for many women and couples. The organization of IVG services must be such that there is enough professional figures to provide women with access to voluntary pregnancy termination. From the latest reports published by the Ministry, there is a noticeable decrease in voluntary pregnancy terminations, a trend also observed among foreign women. This is undoubtedly influenced by the increased use of emergency contraception – Levonorgestrel (morning-after pill) and Ulipristal acetate (5-day after pill). On the other hand, due to the more frequent use of pharmacological termination (using Mifepristone+Prostaglandins), there is an increased access to termination within the first 8 weeks of gestation, which represents the deadline for undergoing this variant of the procedure.

Materials and Methods:
The study is retrospective and uncentered, with an evaluation of data from questionnaires administered to patients who underwent Pregnancy Terminations in the years 2020, 2021, and 2022 at San Giuliano Hospital in Giugliano in Campania (Na), which falls within the territory of the Local Health Authority Napoli 2 Nord.
From the analysis of the questionnaires, it is possible to reconstruct sensitive patient data, including place and  date of birth, residence, domicile, age, origin, education level, as well as all clinical data related to the patient and pregnancy in general. Surgical pregnancy termination compared to pharmacological termination appears to be less common in all three periods considered. The pharmacological method involves taking an antiprogesterone hormone (Mifepristone) followed by an analogue of prostaglandins (Misoprostol). From a cost analysis perspective, the starting point was the Diagnosis Related Group (DRG) of pharmacological and surgical pregnancy terminations in the Campania Region for each method considered.

Results:
The laboratory tests which the patient must undergo in the preliminary phase are the same in all abortion (IG) procedures. In the surgical treatment, the patient is admitted to the day hospital, and under anaesthesia, the gestational sac is removed (an invasive procedure with associated risks). In the pharmacological procedure, the patient makes three hospital visits for the administration of two tablets with different active ingredients and at least one follow-up.

Conclusions:
Although there is a minimal difference between two Diagnosis-Related Groups (DRGs), only 40 euros, the total expenditure is higher in the case of IGF, which prevails significantly in terms of the number of cases compared to IGC. On the other hand, the involvement of professional figures, technical and logistical infrastructure, is inconsistent in IGF, whereas it is much greater in the case of IGC. With IGF, the patient does not undergo any anaesthesia evaluation or surgical intervention, with recovery times estimated to be a few hours and, above all, exposing the patient to fewer risks than the surgical procedure. Additionally, medical and healthcare staff and the operating room structure with all intervention techniques are engaged to a lesser extent in IGF compared to IGC, generating potentially higher company marginality in IGF, especially considering the actual cost of the drugs used. It is worth noting that the DRG falls under regional jurisdiction and may not be the same across the entire national territory. In fact, the Campania Region's case may be different in other regions, resulting in a higher reimbursement amount for IGC treatment compared to IGF.