Liem S M S, van Baaren G J, Delemarre F M C, Evers I M, Kleiverda G, van Loon A J, Langenveld J, Schuitemaker N, Sikkema J M, Opmeer B C, van Pampus M G, Mol B W J, Bekedam D J
Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2014 Sep;44(3):338-45. doi: 10.1002/uog.13432. Epub 2014 Aug 7.
To assess the cost-effectiveness of a cervical pessary to prevent preterm delivery in women with a multiple pregnancy.
The study design comprised an economic analysis of data from a randomized clinical trial evaluating cervical pessaries (ProTWIN). Women with a multiple pregnancy were included and an economic evaluation was performed from a societal perspective. Costs were estimated between the time of randomization and 6 weeks postpartum. The prespecified subgroup of women with a cervical length (CL) < 25(th) centile (< 38 mm) was analyzed separately. The primary endpoint was poor perinatal outcome occurring up to 6 weeks postpartum. Direct medical costs and health outcomes were estimated and incremental cost-effectiveness ratios for costs to prevent one poor outcome were calculated.
Mean costs in the pessary group (n = 401) were € 21,783 vs € 21,877 in the group in which no pessary was used (n = 407) (difference, -€ 94; 95% CI, -€ 5975 to € 5609). In the prespecified subgroup of women with a CL < 38 mm we demonstrated a significant reduction in poor perinatal outcome (12% vs 29%; RR, 0.40; 95% CI, 0.19-0.83). Mean costs in the pessary group (n = 78) were € 25,141 vs € 30,577 in the no-pessary group (n = 55) (difference, -€ 5436 (95% CI, -€ 11,001 to € 1456). In women with a CL < 38 mm, pessary treatment was the dominant strategy (more effective and less costly) with a probability of 94%.
Cervical pessaries in women with a multiple pregnancy involve costs comparable to those in women without pessary treatment. However, in women with a CL < 38 mm, treatment with a cervical pessary appears to be highly cost-effective.
评估宫颈托预防多胎妊娠妇女早产的成本效益。
研究设计包括对一项评估宫颈托（ProTWIN）的随机临床试验数据进行经济分析。纳入多胎妊娠妇女，并从社会角度进行经济评估。在随机分组至产后6周期间估算成本。对宫颈长度（CL）<第25百分位数（<38 mm）的预设亚组进行单独分析。主要终点是产后6周内发生的不良围产期结局。估算直接医疗成本和健康结局，并计算预防一例不良结局的成本的增量成本效益比。
宫颈托组（n = 401）的平均成本为21,783欧元，未使用宫颈托组（n = 407）为21,877欧元（差异为-94欧元；95%CI，-5975欧元至5609欧元）。在CL<38 mm的预设亚组中，我们证明不良围产期结局显著降低（12%对29%；RR，0.40；95%CI，0.19 - 0.83）。宫颈托组（n = 78）的平均成本为25,141欧元，无宫颈托组（n = 55）为30,577欧元（差异为-5436欧元（95%CI，-11,001欧元至1456欧元）。在CL<38 mm的妇女中，宫颈托治疗是占优策略（更有效且成本更低），概率为94%。
多胎妊娠妇女使用宫颈托的成本与未接受宫颈托治疗的妇女相当。然而,对于宫颈长度<38 mm的妇女，使用宫颈托治疗似乎具有很高的成本效益。
