| Sumario: | Mifepristone and misoprostol (Mifegymiso) is a combination drug product comprising a progesterone receptor antagonist and a synthetic analogue of prostaglandin E1. It is approved by Health Canada for the medical termination of a developing intrauterine pregnancy with a gestational age up to 49 days. Each box contains one 200 mg tablet of mifepristone and four 200 mcg tablets of misoprostol, and is administered as a sequential regimen of a single oral dose of mifepristone followed by a single buccal dose of misoprostol 24 to 48 hours later. The individual ingredients of Mifegymiso cannot be sold separately, and the manufacturer's submitted confidential price for a single kit is $300. The manufacturer submitted a cost-minimization analysis (CMA) comparing mifepristone plus misoprostol to methotrexate plus misoprostol, vacuum aspiration in hospital, and vacuum aspiration in a free-standing clinic. The modelled patient population was broader than the Health Canada-approved population, as it included pregnant women up to 63 days of gestation. The manufacturer's analysis was based on a decision tree that captured treatment success and complications (i.e., excessive bleeding, infection). By the end of the model, pregnancy was considered terminated in all patients regardless of the initial abortion strategy. Under a health care system perspective, the manufacturer reported that the expected costs for mifepristone plus misoprostol were $582.56, which is $201.87 more than methotrexate plus misoprostol and $79.42 more than vacuum aspiration in clinic, but $445.97 less than vacuum aspiration in hospital.
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