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Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis

Published:January 18, 2010DOI:https://doi.org/10.1016/j.ajog.2009.12.005

      Objective

      The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity.

      Study Design

      We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years, cost in US dollars, and number of preterm births prevented.

      Results

      Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and was the dominant choice over the 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 α-hydroxyprogesterone caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1339 ($8325 vs $9664), when compared with treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the United States.

      Conclusion

      Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears to be cost-effective and yields the greatest reduction in preterm birth at <34 weeks' gestation.

      Key words

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      Linked Article

      • Skewed analysis
        American Journal of Obstetrics & GynecologyVol. 204Issue 5
        • Preview
          While Cahill et al1 are to be credited for considerable work addressing an important problem in their decision and economic analysis, the numbers don't add up, and the conclusion is unsubstantiated.
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