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

Brett D. Einerson*, William A. Grobman, Emily S. Miller

*Corresponding author for this work

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)100.e1-100.e7
JournalAmerican journal of obstetrics and gynecology
Volume215
Issue number1
DOIs
StatePublished - Jul 1 2016

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Keywords

  • cervical length
  • cost-effectiveness
  • preterm birth
  • screening

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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