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Vasa previa screening strategies: decision and cost-effectiveness analysis
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Summary
Screening pregnancies conceived by in-vitro fertilization (IVF) for vasa previa is the most cost-effective antenatal diagnostic strategy. Ultrasound-indicated screening is also cost-effective, suggesting both approaches are suitable for clinical practice.
Area of Science:
- Maternal-fetal medicine
- Diagnostic imaging
- Health economics
Background:
- Vasa previa diagnosis is crucial for preventing adverse perinatal outcomes.
- Current screening strategies vary, impacting cost-effectiveness.
- In-vitro fertilization (IVF) pregnancies have a higher risk of vasa previa.
Purpose of the Study:
- To compare the cost-effectiveness of four antenatal vasa previa screening strategies.
- To identify the optimal screening approach for singleton pregnancies.
Main Methods:
- A decision-analytic model was used to compare screening strategies.
- Four scenarios were evaluated: no screening, ultrasound-indicated, IVF-only, and universal screening.
- Cost per Quality-Adjusted Life Year (QALY) was the primary outcome measure, analyzed from a healthcare system perspective.
Main Results:
- Screening IVF pregnancies yielded the highest cost-effectiveness (ICER: $29,186.50/QALY).
- Ultrasound-indicated screening was the second most cost-effective strategy (ICER: $56,096.77/QALY).
- Results remained robust across sensitivity analyses.
Conclusions:
- Antenatal transvaginal ultrasound screening for vasa previa is most cost-effective in IVF pregnancies.
- Both IVF-specific and ultrasound-indicated screening strategies are within acceptable willingness-to-pay thresholds.
- These findings support the clinical application of both IVF and ultrasound-indicated screening for vasa previa.
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