Late Pregnancy Ultrasound to Screen for and Manage Potential Birth Complications in Nulliparous Women: A Cost-Effectiveness and Value of Information Analysis

Apr 1, 2021, 00:00
10.1016/j.jval.2020.11.005
https://www.valueinhealthjournal.com/article/S1098-3015(20)34513-7/fulltext
Title : Late Pregnancy Ultrasound to Screen for and Manage Potential Birth Complications in Nulliparous Women: A Cost-Effectiveness and Value of Information Analysis
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(20)34513-7&doi=10.1016/j.jval.2020.11.005
First page : 513
Section Title : ECONOMIC EVALUATION
Open access? : No
Section Order : 513

Background

Fetal growth restriction is a major risk factor for stillbirth. A routine late-pregnancy ultrasound scan could help detect this, allowing intervention to reduce the risk of stillbirth. Such a scan could also detect fetal presentation and predict macrosomia. A trial powered to detect stillbirth differences would be extremely large and expensive.

Objectives

It is therefore critical to know whether this would be a good investment of public research funds. The aim of this study is to estimate the cost-effectiveness of various late-pregnancy screening and management strategies based on current information and predict the return on investment from further research.

Methods

Synthesis of current evidence structured into a decision model reporting expected costs, quality-adjusted life-years, and net benefit over 20 years and value-of-information analysis reporting predicted return on investment from future clinical trials.

Results

Given a willingness to pay of £20 000 per quality-adjusted life-year gained, the most cost-effective strategy is a routine presentation-only scan for all women. Universal ultrasound screening for fetal size is unlikely to be cost-effective. Research exploring the cost implications of induction of labor has the greatest predicted return on investment. A randomized, controlled trial with an endpoint of stillbirth is extremely unlikely to be a value for money investment.

Conclusion

Given current value-for-money thresholds in the United Kingdom, the most cost-effective strategy is to offer all pregnant women a presentation-only scan in late pregnancy. A randomized, controlled trial of screening and intervention to reduce the risk of stillbirth following universal ultrasound to detect macrosomia or fetal growth restriction is unlikely to represent a value for money investment.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Diagnostics & Imaging
  • Economic Evaluation
  • Medical Technologies
  • Study Approaches
  • Value of Information
Tags :
  • economic evaluation
  • pregnancy
  • third trimester
  • ultrasound
  • value of information analysis
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