Department of Obstetrics, Gynecology & Reproductive Sciences, Section of Maternal Fetal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
Ultrasound Obstet Gynecol. 2011 Jul;38(1):32-7. doi: 10.1002/uog.8911. Epub 2011 May 24.
To determine whether routine measurement of second-trimester transvaginal cervical length by ultrasound in low-risk singleton pregnancies is a cost-effective strategy.
We developed a decision analysis model to compare the cost-effectiveness of two strategies for identifying pregnancies at risk for preterm birth: (1) no routine cervical length screening and (2) a single routine transvaginal cervical length measurement at 18-24 weeks' gestation. In our model, women identified as being at increased risk (cervical length < 1.5 cm) for preterm birth would be offered daily vaginal progesterone supplementation. We assumed that vaginal progesterone reduces preterm birth at < 34 weeks' gestation by 45%. We also assumed that a decreased cervical length could result in additional costs (ultrasound scans, inpatient admission) without significantly improved neonatal outcomes. The main outcome measure was incremental cost-effectiveness ratio.
Our model predicts that routine cervical-length screening is a dominant strategy when compared to routine care. For every 100,000 women screened, $12,119,947 can be potentially saved (in 2010 US dollars) and 423.9 quality-adjusted life-years could be gained. Additionally, we estimate that 22 cases of neonatal death or long-term neurologic deficits could be prevented per 100,000 women screened. Screening remained cost-effective but was no longer the dominant strategy when cervical-length ultrasound measurement costs exceeded $187 or when vaginal progesterone reduced delivery risk at < 34 weeks by less than 20%.
In low-risk pregnancies, universal transvaginal cervical length ultrasound screening appears to be a cost-effective strategy under a wide range of clinical circumstances (varied preterm birth rates, predictive values of a shortened cervix and costs).
确定在低危单胎妊娠中常规经阴道超声测量中孕期宫颈长度是否是一种具有成本效益的策略。
我们开发了一个决策分析模型，以比较两种识别早产风险妊娠的策略的成本效益：（1）不进行常规宫颈长度筛查，（2）在 18-24 孕周时进行单次常规经阴道宫颈长度测量。在我们的模型中，被认为有早产风险（宫颈长度<1.5cm）的妇女将接受每日阴道孕酮补充治疗。我们假设阴道孕酮可将<34 孕周的早产率降低 45%。我们还假设宫颈长度缩短可能会导致额外的费用（超声检查、住院治疗），但新生儿结局并无显著改善。主要结局指标是增量成本效益比。
与常规护理相比，我们的模型预测常规宫颈长度筛查是一种主导策略。在每 10 万名筛查的妇女中，可以潜在节省 12119947 美元（2010 年的美元），并获得 423.9 个质量调整生命年。此外，我们估计每筛查 10 万名妇女可以预防 22 例新生儿死亡或长期神经发育缺陷。当宫颈长度超声测量成本超过 187 美元，或阴道孕酮降低<34 孕周的分娩风险低于 20%时，筛查仍具有成本效益，但不再是主导策略。
在低危妊娠中，常规经阴道超声宫颈长度筛查似乎是一种具有成本效益的策略，在各种临床情况下（不同的早产率、缩短宫颈的预测值和成本）都适用。
