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Universal cervical length screening to prevent preterm birth: a cost-effectiveness analysis.
MedLine Citation:
PMID:  21157771     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether routine 2(nd) trimester transvaginal cervical length ultrasound in low risk singleton pregnancies is a cost-effective strategy. METHODS: We developed a decision analysis model to compare the cost-effectiveness of two strategies to identify pregnancies at risk for preterm birth: 1) no routine cervical length screening and 2) a single routine transvaginal cervical length measurement at 18-24 weeks gestation. In our model, women identified at increased risk (cervical length <1.5cm) for preterm birth would be offered daily vaginal progesterone supplementation. We assumed that vaginal progesterone reduced preterm birth <34 weeks gestation by 45%. We also assumed that a decreased cervical length could result in additional costs (ultrasounds, inpatient admission) without significantly improved neonatal outcomes. The main outcome measure was Incremental Cost-Effectiveness Ratio (ICER). RESULTS: Our model predicts that routine cervical length screening is a dominant strategy when compared to routine care. For every 100,000 women screened, $12,119,947 can be potentially saved (in 2010 dollars) and 423.9 quality adjusted life-years (QALY) could be gained. Additionally, we estimate that 22 cases of neonatal death or long-term neurologic deficits could be prevented per 100,000 women screened. Screening remained cost-effective but was no longer the dominant strategy when cervical length ultrasound costs exceeded $187 or when vaginal progesterone reduced delivery risk <34 weeks by less than 20%. CONCLUSION: In low-risk pregnancies, universal transvaginal cervical length ultrasound screening appears to be a cost-effective strategy under a wide range of clinical circumstances (varied preterm birth rates, predictive values of a shortened cervix and costs).Universal transvaginal cervical length ultrasound screening appears to be a cost-effective strategy under a wide range of clinical circumstances. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Erika F Werner; Christina S Han; Christian M Pettker; Catalin S Buhimschi; Joshua A Copel; Edmund F Funai; Stephen F Thung
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-14
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Obstetrics, Gynecology & Reproductive Sciences, Section of Maternal Fetal Medicine, 333 Cedar Street, P.O. Box 208063, New Haven, CT 06520.
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