1 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran


Pregnancy termination and abortion‑related complications are well‑established problems among
women at reproductive age and resulted in significant morbidity and mortality. Accordingly, a
systematic study was performed to investigate the economic evaluation studies results on costs
and benefits of medical and surgical abortion methods. PubMed, Web of Science, Scopus, Embase,
Cochrane library, ProQuest, and ScienceDirect databases as well as Google scholar were searched
through June 2021. Original full‑text English language studies that performed an economic evaluation
analysis comparing medical and surgical methods of pregnancy termination were included in this
review. A critical quality assessment was conducted utilizing the Consolidated Health Economic
Evaluation Standards checklist. The latest web‑based tool adjusted the estimates of costs expressed
in one specific currency and price year into a specific target currency (the year 2020 $US). Overall,
538 records were retrieved, and 20 studies were deemed eligible for qualitative synthesis. Among
the reviewed studies, three studies investigated cost‑minimization analysis, three studies investigated
cost‑utility analysis, and 14 studies investigated cost‑effectiveness analysis. The directly comparison
of medical with surgical abortion was most frequently studied. Medical abortion saved US$ 6 to US$
2373 per patient’s costs. Medical abortion was cost‑effective and cost‑saving option in compare to
the surgical abortion across all perspectives (the incremental cost effectiveness ratio ranged from
US$ 419 to US$ 4,044). Quality scores of included studies ranged from 54% to 100%, and 70% of
studies received a score of above 85% and had “excellent” quality. According to the results, based on
various economic and clinical effectiveness decision‑making criteria used in different studies of health
economic evaluation, the majority of research provided evidence on the advantage of pharmaceutical
methods compared to surgical methods, as well as the advantages of using combinations therapy
compared to single therapeutic interventions.


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