Cost-Effectiveness Analysis of First-Trimester Ultrasound Screening for Fetal Structural Abnormalities in China

OBJECTIVES: Ultrasound screening for fetal structural abnormalities have long been used for routine anatomy screening during the second trimester in China. Our study aims to determine the cost-effectiveness of first-trimester fetal structural abnormalities ultrasound screening compared to mid-trimester fetal structural ultrasound screening in China, providing evidence-based support for optimizing clinical pathways.

METHODS: A decision tree model with 18-week horizon was developed from society perspective in China, to simulate the clinical choices and outcomes paths of pregnant women undergoing fetal structural anomaly ultrasound screening in first-trimester (the intervention group) versus ultrasound screening in mid-trimester screening (the control group), evaluating the cost-effectiveness of the two different prenatal screening strategies. The transition probabilities and cost including ultrasound screening programme, confirmatory tests, paediatrician consultations, termination of pregnancy for fetal abnormality (TOPFA), hospitalizations, transportation expenses etc. were obtained from real-world hospital data and national statistics website. The utility value were from the published literature. One-way sensitivity and probability sensitivity analysis were conducted to examine the robustness of the base-case findings.

RESULTS: Using decision tree model simulation, the intervention group dominated the control group with lower unnecessary pregnancies(TOPFA rate in first-trimester:0.59 versus 0.23; TOPFA rate in mid-trimester:0.41 versus 0.77), lower total costs(¥ 2,085 versus ¥ 2,299), higher Quality-adjusted life years(QALYs) (0.2839 versus 0.2825), and resulting in an Incremental Cost-Effectiveness Ratio (ICER) of ¥-161,733/QALY. Findings from the probabilistic sensitivity analysis indicated that the likelihood of the intervention group being cost-effective was 94.60%.

CONCLUSIONS: From society perspective in China, first-trimester fetal structural abnormalities ultrasound screening is more effective and cost-saving compared with mid-trimester fetal structural ultrasound screening. It is recommended that ultrasound screening for structural abnormalities should be extended to the first trimester.