Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis

Objective The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity. Study Design We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted...

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Published in:	American journal of obstetrics and gynecology 2010-06, Vol.202 (6), p.548.e1-548.e8
Main Authors:	Cahill, Alison G., MD, MSCI, Odibo, Anthony O., MD, MSCE, Caughey, Aaron B., MD, PhD, Stamilio, David M., MD, MSCE, Hassan, Sonia S., MD, Macones, George A., MD, MSCE, Romero, Roberto, MD
Format:	Article
Language:	eng
Subjects:	Administration, Intravaginal Biological and medical sciences Cervical Length Measurement - economics cervical length screening Computerized, statistical medical data processing and models in biomedicine Cost-Benefit Analysis - economics Decision Support Techniques Diseases of mother, fetus and pregnancy Female Gynecology. Andrology. Obstetrics Humans Medical management aid. Diagnosis aid Medical sciences Obstetrics - economics Obstetrics and Gynecology Pregnancy Pregnancy. Fetus. Placenta Premature Birth - economics Premature Birth - prevention & control preterm birth prevention progesterone Progesterone - therapeutic use Progestins - therapeutic use Quality-Adjusted Life Years United States
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Summary:	Objective The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity. Study Design We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years, cost in US dollars, and number of preterm births prevented. Results Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and was the dominant choice over the 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 α-hydroxyprogesterone caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1339 ($8325 vs $9664), when compared with treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the United States. Conclusion Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears to be cost-effective and yields the greatest reduction in preterm birth at
ISSN:	0002-9378 1097-6868