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Published on: June 29, 2013
Improving antenatal detection of small-for-gestational-age fetus: economic evaluation of Growth Assessment Protocol
S Relph1, M C Vieira1,2, A Copas3
1Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Insights
The Growth Assessment Protocol (GAP) shows a weak economic case for antenatal detection of small-for-gestational-age (SGA) neonates compared to standard care. Further analysis is needed due to inherent assumptions in cost-effectiveness studies.
Area of Science:
- Obstetrics and Gynecology
- Health Economics
- Perinatal Medicine
Background:
- Small-for-gestational-age (SGA) neonates require accurate antenatal detection for optimal outcomes.
- The Growth Assessment Protocol (GAP) was evaluated against standard care in the DESiGN trial.
- Cost-effectiveness of interventions is crucial for healthcare resource allocation.
Purpose of the Study:
- To assess the cost-effectiveness of the Growth Assessment Protocol (GAP) for antenatal detection of small-for-gestational-age (SGA) neonates.
- To compare GAP with standard care from a UK National Health Service hospital provider perspective.
- To determine the incremental cost-effectiveness ratio (ICER) per additional SGA neonate identified and per quality-adjusted life year (QALY) gained.
Main Methods:
- An incremental cost-effectiveness analysis was conducted using data from the DESiGN cluster randomized controlled trial.
- Probabilistic decision modeling was employed, analyzing singleton, non-anomalous pregnancies.
- Outcomes included incremental cost, additional SGA neonates identified, and ICERs.
Main Results:
- GAP incurred an expected incremental cost of £34,559 per 1000 births, with a 68% probability of increased costs.
- GAP identified an additional 1.77 SGA neonates per 1000 births (55% probability of being more effective).
- The ICER was £19,525 per additional SGA neonate identified; the probability of GAP being the dominant strategy was low (11%).
Conclusions:
- The economic case for adopting GAP over standard care for SGA detection is currently weak.
- Cost-effectiveness findings are contingent upon the assumptions made in the analysis.
- Further research may be needed to fully elucidate the value of GAP in clinical practice.
Objective:
To determine whether the Growth Assessment Protocol (GAP), as implemented in the DESiGN trial, is cost-effective in terms of antenatal detection of small-for-gestational-age (SGA) neonate, when compared with standard care.
Methods:
This was an incremental cost-effectiveness analysis undertaken from the perspective of a UK National Health Service hospital provider. Thirteen maternity units from England, UK, were recruited to the DESiGN (DEtection of Small for GestatioNal age fetus) trial, a cluster randomized controlled trial. Singleton, non-anomalous pregnancies which delivered after 24 + 0 gestational weeks between November 2015 and February 2019 were analyzed. Probabilistic decision modeling using clinical trial data was undertaken. The main outcomes of the study were the expected incremental cost, the additional number of SGA neonates identified antenatally and the incremental cost-effectiveness ratio (ICER) (cost per additional SGA neonate identified) of implementing GAP. Secondary analysis focused on the ICER per infant quality-adjusted life year (QALY) gained.
Results:
The expected incremental cost (including hospital care and implementation costs) of GAP over standard care was £34 559 per 1000 births, with a 68% probability that implementation of GAP would be associated with increased costs to sustain program delivery. GAP identified an additional 1.77 SGA neonates per 1000 births (55% probability of it being more clinically effective). The ICER for GAP was £19 525 per additional SGA neonate identified, with a 44% probability that GAP would both increase cost and identify more SGA neonates compared with standard care. The probability of GAP being the dominant clinical strategy was low (11%). The expected incremental cost per infant QALY gained ranged from £68 242 to £545 940, depending on assumptions regarding the QALY value of detection of SGA.
Conclusion:
The economic case for replacing standard care with GAP is weak based on the analysis reported in our study. However, this conclusion should be viewed taking into account that cost-effectiveness analyses are always limited by the assumptions made. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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