Objective
We sought to reevaluate the cost-effectiveness of universal transvaginal ultrasound
(TVU) cervical length (CL) screening in singleton pregnancies without prior spontaneous
preterm birth.
Study Design
We developed a decision model to assess costs and effects of universal TVU CL screening
at 18-23 weeks’ gestation compared to routine care for singleton pregnancies without
prior preterm birth. Based on recent data, the model contains the following updates:
(1) reduced incidence of CL ≤20 mm at initial screening ultrasound (0.83%), (2) vaginal
progesterone supplementation for women with CL ≤20 mm, (3) additional ultrasound(s)
for women with CL 21-24.9 mm, and (4) the assumption that vaginal progesterone reduces
the rate of preterm birth <34 weeks’ gestation by 39% if a short CL is diagnosed.
The primary outcome was incremental cost-effectiveness ratio. We assumed a willingness
to pay of $100,000 per quality-adjusted life year (QALY) gained. Additional outcomes
included incidence of offspring with long-term neurological deficits and neonatal
death. Sensitivity analyses were performed to assess the robustness of the results.
Results
For every 100,000 women screened, universal TVU CL screening costs $9132 compared
to routine care. Screening results in 215 QALYs gained and 10 fewer neonatal deaths
or neonates with long-term neurologic deficits per 100,000 women screened. Based on
the updated data, universal CL screening in low-risk women remains a cost-effective
strategy (incremental cost-effectiveness ratio = $43/QALY), but is not cost saving
as previously estimated. Sensitivity analyses reveal that when incidence of TVU CL
≤20 mm is <0.31%, universal TVU CL screening is no longer cost-effective. Additionally,
when TVU CL costs >$314, progesterone reduces preterm delivery risk before 34 weeks
<19%, or the incidence of a TVU CL 21-24.9 mm is >6.5%, CL screening is also no longer
cost-effective.
Conclusion
Despite the reduced incidence and efficacy used in this model, universal TVU CL continues
to be cost-effective when compared to routine care in singletons without prior preterm
birth.
Key words
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Article info
Publication history
Published online: June 10, 2015
Accepted:
June 3,
2015
Received in revised form:
May 12,
2015
Received:
March 6,
2015
Footnotes
The authors report no conflict of interest.
Cite this article as: Werner EF, Hamel MS, Orzechowski K, et al. Cost-effectiveness of transvaginal ultrasound cervical length screening in singletons without a prior preterm birth: an update. Am J Obstet Gynecol 2015;213:554.e1-6.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
