Selective laser photocoagulation versus serial amniodrainage for the treatment of twin-twin transfusion syndrome: A cost-effectiveness analysis

Objective: To compare the cost-effectiveness of selective laser photocoagulation (SLP) with serial amniodrainage (AD) in the treatment of twin-to-twin transfusion syndrome (TTTS). Study design: Using decision-analysis modeling, we compared the cost-effectiveness of using laser photocoagulation with AD for the treatment of TTTS. The analysis was carried out from a societal perspective using a theoretical cohort of 1000 women with TTTS. Costs included the costs of procedures, perinatal complications from TTTS and of resources used for raising a child with cerebral palsy (CP) following TTTS. One-way, multiway and probabilistic (Monte Carlo) sensitivity analyses were carried out for all model variables. The main outcome measures were: cost per quality-adjusted life years (QALYs) gained from treating TTTS. Result: On the basis of the available data, the decision model favors SLP as the most cost-effective treatment option compared with AD. Using the theoretical cohort, laser photocoagulation will result in an overall perinatal survival of 59.3% compared with 51.5% for AD. The frequency of children with CP after laser would be 8.5% compared with 15.4% after AD. Sensitivity analyses showed the model to be robust over a wide range of values for the variables, except when the overall survival associated with AD is >62%. Above that survival rate, AD was the more cost-effective therapy. Conclusion: Under a wide range of circumstances, the most cost-effective therapy for TTTS is SLP.