“Preterm birth (PTB) is a significant cause of neonatal morbidity and mortality. Studies have shown that vaginal progesterone therapy for women diagnosed with shortened cervical length can reduce the risk of PTB. However, published cost-effectiveness analyses of vaginal progesterone for short cervix have not considered an appropriate range of clinically important parameters,” notes Mr. Siddharth Jain, doctoral candidate in the department of health care organization and policy at the University of Alabama at Birmingham, in a recent study, conducted in collaboration with department colleague professor and chair Dr. Meredith Kilgore and associate professor Dr. Rodney K. Edwards and professor Dr. John Owen in UAB’s department of obstetrics & gynecology.
The investigators assessed the economic feasibility of performing universal cervical length screening of pregnant women in the United States — assuming all study participants had received progesterone to decrease the probability of PTB — by developing a decision analysis model to evaluate cost-effectiveness of universal screening strategy versus no-screening strategy.
“The primary outcome was the cost-effectiveness ratio of both the strategies, defined as the estimated patient cost per quality adjusted life year (QALY) realized by the children. One-way sensitivity analyses were performed by varying progesterone efficacy to prevent PTB. A probabilistic sensitivity analysis was performed to address uncertainties in model parameter estimates,” reports Mr. Jain. “In our base-case analysis, assuming that progesterone reduces the likelihood of PTB by 11 percent, the incremental cost-effectiveness ratio (ICER) for screening was $158,000 per QALY. Sensitivity analyses show that these results are highly sensitive to the presumed efficacy of progesterone to prevent PTB. In a one-way sensitivity analysis, screening results in cost-saving if progesterone can reduce PTB by 36 percent.”
The researchers concluded that cervical length screening is not financially practical unless treatment with progesterone proves in future trials to be more effective than data for American women so far suggest.
“Revisiting the Cost-Effectiveness of Universal Cervical Length Screening: Importance of Progesterone Efficacy” was published online in January in the American Journal of Obstetrics and Gynecology.
Journal article: http://www.ajog.org/article/S0002-9378(16)00215-5/abstract