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Related Experiment Videos

Predicting preterm birth: a cost-effectiveness analysis.

E L Mozurkewich1, G Naglie, M D Krahn

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, USA.

American Journal of Obstetrics and Gynecology
|June 28, 2000
PubMed
Summary
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Risk prediction strategies using fetal fibronectin or cervical length measurements may reduce costs for threatened preterm labor management. These approaches offer similar outcomes to treating all patients, preventing respiratory distress syndrome and neonatal deaths.

Area of Science:

  • Perinatal medicine
  • Health economics
  • Clinical decision-making

Background:

  • Preterm labor management involves significant costs and clinical decisions.
  • Evaluating cost-effectiveness of different management strategies is crucial for optimizing resource allocation.
  • Existing strategies include universal treatment, selective treatment based on tests, and no treatment.

Purpose of the Study:

  • To compare the cost-effectiveness of nine distinct management strategies for threatened preterm labor.
  • To identify strategies that balance cost savings with prevention of adverse neonatal outcomes.

Main Methods:

  • Decision analytic modeling was employed to compare nine management strategies.
  • Data on probabilities, costs, and outcomes (respiratory distress syndrome, neonatal death) were derived from literature and institutional statistics.

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  • Sensitivity analyses were performed on all variables.

    • Main Results:

    • Universal corticosteroid administration was least expensive but had higher mortality and morbidity.
    • Strategies combining rapid fetal fibronectin testing or cervical length assessment with corticosteroids demonstrated favorable cost-effectiveness, similar to treating all patients.
    • Treating all patients resulted in the fewest adverse outcomes but incurred the highest costs.

    Conclusions:

    • Risk prediction strategies utilizing fetal fibronectin assay or cervical length assessment, combined with corticosteroids, may provide cost savings.
    • These strategies can achieve comparable reductions in respiratory distress syndrome and neonatal deaths versus universal treatment.
    • Selective management based on risk prediction may be a more cost-effective approach for threatened preterm labor.