Cost-effectiveness of transvaginal ultrasound cervical length screening in singletons without a prior preterm birth: an update

• Published in: American journal of obstetrics and gynecology 2015-10, Vol.213 (4), p.554.e1-554.e6
• Main Authors: Werner, Erika F., MD, Hamel, Maureen S., MD, Orzechowski, Kelly, MD, Berghella, Vincenzo, MD, Thung, Stephen F., MD
• Format: Article
• Language: English
• Subjects: Administration, Intravaginal; cervical length; Cervical Length Measurement - economics; Cervix Uteri - diagnostic imaging; Cost-Benefit Analysis; Decision Support Techniques; Female; Humans; Infant, Newborn; Obstetrics and Gynecology; Pregnancy; Pregnancy Trimester, Second; Premature Birth - economics; Premature Birth - prevention & control; preterm birth; progesterone; Progesterone - therapeutic use; Progestins - therapeutic use; Quality-Adjusted Life Years; Risk Assessment; transvaginal ultrasound
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.06.020

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