**6. Cost analysis**

Serial serum beta-hCG measurements and transvaginal ultrasound examination can provide early diagnosis of most ectopic pregnancies allowing medical treatment with methotrexate. Approximately 40% of women diagnosed with ectopic pregnancy are candidates for medical management (Barnhart et al., 2003), and 90% of those can be treated successfully without surgery (Lipscomb et al., 2000). Whereas the costs of surgery and outpatient medical management vary widely, many cost-effectiveness analyses have favored MTX therapy. Systemic MTX in a single-dose regimen resulted in significant savings in direct costs compared with laparoscopic surgery: mean direct costs per patient were € 756 and € 1585, respectively, with a mean difference of € 829 (95% CI 599–1060). Furthermore, systemic MTX resulted in significant savings in indirect costs: mean indirect costs per patient were € 587 and € 977, respectively, with a mean difference of € 390 (95% CI 142–638). However, in women with initial serum hCG concentrations >1500 IU/l the difference in indirect costs was lost due to the prolonged follow-up and a higher rate of surgical re-interventions (Sowter et al., 2001). Therefore, medical treatment is less expensive than surgery, except in cases with higher levels of beta-hCG (Sowter et al., 2001).
