Evidence map›Paper›PMID 32003141›Full record

ArticleBJOG : an international journal of obstetrics and gynaecology2020

The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial.

C B Okeke Ogwulu, I Goranitis, A J Devall, V Cheed, I D Gallos, L J Middleton, H M Harb, H M Williams, A Eapen, J P Daniels and 31 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BJOG : an international journal of obstetrics and gynaecology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 12 citations in OpenAlex.

  1. Trial
  2. Progestogen supplementation to prevent miscarriage: Evidence and controversies.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

41 authors at 20 institutions in 3 countries.

C B Okeke OgwuluHealth Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
I GoranitisHealth Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
A J DevallCollege of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
V CheedCollege of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.ORCID 0000-0002-6713-0913
I D GallosCollege of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
L J MiddletonCollege of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
H M HarbCollege of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
H M WilliamsCollege of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
A EapenCarver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
J P DanielsFaculty of Medicine & Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
A AhmedSunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.
R Bender-AtikThe Miscarriage Association, Wakefield, UK.
K BhatiaBurnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK.
C BottomleyUniversity College Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
J BrewinTommy's Charity, London, UK.
M ChoudharyRoyal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
S DebQueen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
W C DuncanMRC Centre for Reproductive Health, the Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
A K EwerCollege of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
K HinshawSunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.
T HollandGuy's and St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
F IzzatUniversity Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
J JohnsKings College Hospital, King's College Hospital NHS Foundation Trust, London, UK.
M LumsdenAcademic Unit of Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK.
P MandaJames Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
J E NormanFaculty of Health Sciences, University of Bristol, Bristol, UK.
N NunesWest Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Isleworth, UK.
C E OvertonSt Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
K KriedtUniversity College Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
S QuenbyBiomedical Research Unit in Reproductive Health, University of Warwick, Warwick, UK.
S RaoWhiston Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Whiston, Prescot, UK.
J RossAcademic Unit of Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK.
A ShahidWhipps Cross Hospital, Barts Health NHS Trust, Leytonstone, London, UK.
M UnderwoodPrincess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Apley, Telford, UK.
N VaithilinghamPortsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth, UK.
L WatkinsLiverpool Women's Hospital, Liverpool Women's NHS Foundation Trust, Liverpool Women's Hospital, Liverpool, UK.
C WykesEast Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK.
A W HorneMRC Centre for Reproductive Health, the Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
D JurkovicUniversity College Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
A CoomarasamyCollege of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
T E RobertsHealth Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
University of Birmingham · GBUniversity College Hospital · GBMRC Centre for Reproductive Health · GBPrincess Royal Maternity Hospital · GBSunderland Royal Hospital · GBBarts Health NHS Trust · GBBurnley General Teaching Hospital · GBChelsea and Westminster Hospital NHS Foundation Trust · GBEast Surrey Hospital · GBJames Cook University Hospital · GBKing's College Hospital NHS Foundation Trust · GBMiscarriage Association · GBNottingham University Hospitals NHS Trust · GBPrincess Royal Hospital · GBQueen Alexandra Hospital · GBRoyal Victoria Infirmary · GBSt Helens and Knowsley Teaching Hospitals NHS Trust · GBSt Thomas' Hospital · GBThe University of Melbourne · AUTommy's · GB

Funding

Department of Health 12/167/26Medical Research Council G0700452Medical Research Council G0802808Medical Research Council MC_PC_16003Medical Research Council MR/N022556/1NHSNIHRNIHR Evaluation, Trials and Studies Coordinating Centre, the Health Technology Assessment Programmethe Medical Research Council, the Central Commissioning FacilityUK NIHR Health Technology Assessment programme HTA 12/167/26
6 · The paper itself

Abstract

objectivesTo assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding.

designEconomic evaluation alongside a large multi-centre randomised placebo-controlled trial.

settingForty-eight UK NHS early pregnancy units. POPULATION: Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac.

methodsAn incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages.

main outcome measuresCost per additional live birth at ≥34 weeks of gestation.

resultsProgesterone intervention led to an effect difference of 0.022 (95% CI -0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI -£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014-0.096) and this was associated with a cost saving of £322 (95% CI -£1318 to £673).

conclusionsThe results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). TWEETABLE ABSTRACT: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.

Indexed as

Abortion, SpontaneousAdolescentAdultCost-Benefit AnalysisDouble-Blind MethodFemaleHumansLive BirthPregnancyProgesteroneProgestinsRandomized Controlled Trials as TopicState MedicineTreatment OutcomeUnited KingdomUterine HemorrhageProgesteroneProgestinsCost-effectivenesseconomic evaluationmiscarriageprogesterone

Identifiers

PMID32003141
PMCPMC7187468
OpenAlexW3004118706

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.