Erika F Werner1, Maureen S Hamel2, Kelly Orzechowski3, Vincenzo Berghella4, Stephen F Thung5. 1. Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI. Electronic address: ewerner@wihri.org. 2. Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI. 3. Virginia Hospital Center Physician Group, Arlington, VA. 4. Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA. 5. Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH.
Abstract
OBJECTIVE: We sought to reevaluate the cost-effectiveness of universal transvaginal ultrasound (TVU) cervical length (CL) screening in singleton pregnancies without prior spontaneous preterm birth. STUDY DESIGN: We developed a decision model to assess costs and effects of universal TVU CL screening at 18-23 weeks' gestation compared to routine care for singleton pregnancies without prior preterm birth. Based on recent data, the model contains the following updates: (1) reduced incidence of CL ≤20 mm at initial screening ultrasound (0.83%), (2) vaginal progesterone supplementation for women with CL ≤20 mm, (3) additional ultrasound(s) for women with CL 21-24.9 mm, and (4) the assumption that vaginal progesterone reduces the rate of preterm birth <34 weeks' gestation by 39% if a short CL is diagnosed. The primary outcome was incremental cost-effectiveness ratio. We assumed a willingness to pay of $100,000 per quality-adjusted life year (QALY) gained. Additional outcomes included incidence of offspring with long-term neurological deficits and neonatal death. Sensitivity analyses were performed to assess the robustness of the results. RESULTS: For every 100,000 women screened, universal TVU CL screening costs $9132 compared to routine care. Screening results in 215 QALYs gained and 10 fewer neonatal deaths or neonates with long-term neurologic deficits per 100,000 women screened. Based on the updated data, universal CL screening in low-risk women remains a cost-effective strategy (incremental cost-effectiveness ratio = $43/QALY), but is not cost saving as previously estimated. Sensitivity analyses reveal that when incidence of TVU CL ≤20 mm is <0.31%, universal TVU CL screening is no longer cost-effective. Additionally, when TVU CL costs >$314, progesterone reduces preterm delivery risk before 34 weeks <19%, or the incidence of a TVU CL 21-24.9 mm is >6.5%, CL screening is also no longer cost-effective. CONCLUSION: Despite the reduced incidence and efficacy used in this model, universal TVU CL continues to be cost-effective when compared to routine care in singletons without prior preterm birth.
OBJECTIVE: We sought to reevaluate the cost-effectiveness of universal transvaginal ultrasound (TVU) cervical length (CL) screening in singleton pregnancies without prior spontaneous preterm birth. STUDY DESIGN: We developed a decision model to assess costs and effects of universal TVU CL screening at 18-23 weeks' gestation compared to routine care for singleton pregnancies without prior preterm birth. Based on recent data, the model contains the following updates: (1) reduced incidence of CL ≤20 mm at initial screening ultrasound (0.83%), (2) vaginal progesterone supplementation for women with CL ≤20 mm, (3) additional ultrasound(s) for women with CL 21-24.9 mm, and (4) the assumption that vaginal progesterone reduces the rate of preterm birth <34 weeks' gestation by 39% if a short CL is diagnosed. The primary outcome was incremental cost-effectiveness ratio. We assumed a willingness to pay of $100,000 per quality-adjusted life year (QALY) gained. Additional outcomes included incidence of offspring with long-term neurological deficits and neonatal death. Sensitivity analyses were performed to assess the robustness of the results. RESULTS: For every 100,000 women screened, universal TVU CL screening costs $9132 compared to routine care. Screening results in 215 QALYs gained and 10 fewer neonatal deaths or neonates with long-term neurologic deficits per 100,000 women screened. Based on the updated data, universal CL screening in low-risk women remains a cost-effective strategy (incremental cost-effectiveness ratio = $43/QALY), but is not cost saving as previously estimated. Sensitivity analyses reveal that when incidence of TVU CL ≤20 mm is <0.31%, universal TVU CL screening is no longer cost-effective. Additionally, when TVU CL costs >$314, progesterone reduces preterm delivery risk before 34 weeks <19%, or the incidence of a TVU CL 21-24.9 mm is >6.5%, CL screening is also no longer cost-effective. CONCLUSION: Despite the reduced incidence and efficacy used in this model, universal TVU CL continues to be cost-effective when compared to routine care in singletons without prior preterm birth.
Authors: Lorene A Temming; Jennifer K Durst; Methodius G Tuuli; Molly J Stout; Jeffrey M Dicke; George A Macones; Alison G Cahill Journal: Am J Obstet Gynecol Date: 2016-02-10 Impact factor: 8.661
Authors: G R Saade; E A Thom; W A Grobman; J D Iams; B M Mercer; U M Reddy; A T N Tita; D J Rouse; Y Sorokin; R J Wapner; K J Leveno; S C Blackwell; M S Esplin; J E Tolosa; J M Thorp; S N Caritis; J P Vandorsten Journal: Ultrasound Obstet Gynecol Date: 2018-10-26 Impact factor: 7.299
Authors: Agustin Conde-Agudelo; Roberto Romero; Eduardo Da Fonseca; John M O'Brien; Elcin Cetingoz; George W Creasy; Sonia S Hassan; Offer Erez; Percy Pacora; Kypros H Nicolaides Journal: Am J Obstet Gynecol Date: 2018-04-07 Impact factor: 8.661
Authors: R Romero; K H Nicolaides; A Conde-Agudelo; J M O'Brien; E Cetingoz; E Da Fonseca; G W Creasy; S S Hassan Journal: Ultrasound Obstet Gynecol Date: 2016-07-19 Impact factor: 7.299
Authors: Roberto Romero; Agustin Conde-Agudelo; Eduardo Da Fonseca; John M O'Brien; Elcin Cetingoz; George W Creasy; Sonia S Hassan; Kypros H Nicolaides Journal: Am J Obstet Gynecol Date: 2017-11-17 Impact factor: 8.661