Cost-effectiveness of risk-based screening for cervical length to prevent preterm birth

Background Despite much debate, there is no consensus on whether women without a history of prior spontaneous preterm birth should receive universal cervical length screening. Risk-based screening has been proposed as an alternative to universal cervical length measurement and may represent a more cost-effective approach to preterm birth prevention. Objective We sought to evaluate the cost-effectiveness of risk-based screening compared to universal cervical length screening or no screening for preterm birth prevention in low-risk women. Study Design A decision analytic model compared the cost and effectiveness of 3 cervical length screening strategies in a population of women with no prior preterm birth. Risk-based screening, universal screening, and no screening were compared using cost, probability, and utility estimates derived from the existing literature and the incremental cost-effectiveness ratios for each strategy were calculated. Results In the base-case analysis, risk-based screening and universal screening were more effective and less costly than no screening. In comparison to the risk-based strategy, universal screening of the United States population of women without a prior preterm birth (N = 3.5 million annually) would result in 2.19 million more transvaginal ultrasounds, 11,027 more women treated with vaginal progesterone, 913 fewer preterm births <35 weeks gestational age, and 63 fewer neonatal deaths at an additional cost of $51,936,699 annually. Despite costing more, the additional health benefits of universal screening resulted in that strategy being more cost-effective than risk-based screening, with an incremental cost-effectiveness ratio of $21,144 per quality-adjusted life-year. Conclusion In women without a prior spontaneous preterm birth, universal cervical length screening is cost-effective in comparison to both risk-based screening and no screening.