Research
Obstetric
Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis

https://doi.org/10.1016/j.ajog.2009.12.005Get rights and content

Objective

The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity.

Study Design

We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years, cost in US dollars, and number of preterm births prevented.

Results

Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and was the dominant choice over the 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 α-hydroxyprogesterone caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1339 ($8325 vs $9664), when compared with treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the United States.

Conclusion

Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears to be cost-effective and yields the greatest reduction in preterm birth at <34 weeks' gestation.

Section snippets

Materials and Methods

We designed a decision analytic model to compare 4 strategies for the reduction of preterm birth in singleton pregnancies based on available published evidence to determine the optimal strategy and the cost-effectiveness of that strategy. Specifically, the model was designed to compare (1) the strategy of universal screening of cervical length with transvaginal ultrasound at the time of routine anatomic survey and treatment with daily vaginal progesterone for women with a short cervix, (2)

Results

The strategy of universal sonographic screening for cervical length and daily treatment with vaginal progesterone for women with a cervical length of ≤15 mm was the most cost-effective strategy and was dominant (lower total costs with better outcomes) over the 3 alternatives (Table 3). The base-case analysis also revealed that all 3 strategies with some form of screening and/or preventative therapy for preterm birth was more cost-effective than no screening or treatment.

We considered a

Comment

It is imperative that efforts are made to integrate and apply the available high-level evidence optimally to identify the clinical strategy that maximizes and best allocates preterm birth prevention methods. This model suggests that a strategy of universal cervical length screening at the time of the routine fetal anatomy sonogram to identify women with a cervical length of ≤15 mm and subsequent treatment with vaginal progesterone is the most cost-effective strategy with the greatest reduction

References (36)

  • B.M. Mercer et al.

    The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome: National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

    Am J Obstet Gynecol

    (1999)
  • C.T. Pham et al.

    Birth outcomes: utility values that postnatal women, midwives and medical staff express

    BJOG

    (2003)
  • T.J. Mathews et al.

    Infant mortality statistics from the 1998 period linked birth/infant death data set

    Natl Vital Stat Rep

    (2000)
  • J.C. Carey et al.

    Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis: National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units

    N Engl J Med

    (2000)
  • R.L. Goldenberg et al.

    The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births: National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

    Am J Public Health

    (1998)
  • J.C. Hauth et al.

    Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis

    N Engl J Med

    (1995)
  • J.D. Iams et al.

    The length of the cervix and the risk of spontaneous premature delivery: National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network

    N Engl J Med

    (1996)
  • C.J. Lockwood et al.

    Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery

    N Engl J Med

    (1991)
  • Cited by (133)

    • The Value of Transvaginal Ultrasonography in Management of Preterm Birth in Singletons

      2023, Donald School Journal of Ultrasound in Obstetrics and Gynecology
    View all citing articles on Scopus

    Reprints not available from the authors.

    Funded in part by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH/DHHS.

    Cite this article as: Cahill AG, Odibo AO, Caughey AB, et al. Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis. Am J Obstet Gynecol 2010;202:548.e1-8.

    View full text