Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
Ultrasound Obstet Gynecol. 2018 Oct;52(4):522-529. doi: 10.1002/uog.19098. Epub 2018 Sep 2.
To perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa in singleton pregnancies.
A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios that were carried out at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening only pregnancies conceived by in-vitro fertilization (IVF) and universal screening. Ultrasound-indicated screening was defined as performing transvaginal ultrasound at the time of the routine anatomy ultrasound scan in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality-adjusted life year (QALY) in US$. The analysis was performed from a healthcare system perspective with a willingness-to-pay threshold of $100 000 per QALY selected. One-way and multivariate sensitivity analysis (Monte-Carlo simulation) was performed.
This decision-analytic model demonstrated that screening pregnancies conceived by IVF was the most cost-effective strategy, with an incremental cost effectiveness ratio (ICER) of $29186.50/QALY. Ultrasound-indicated screening was the second most cost-effective, with an ICER of $56096.77/QALY. These data were robust to all one-way and multivariate sensitivity analyses performed.
Within the baseline assumptions, transvaginal ultrasound screening for vasa previa appears to be most cost-effective when performed among IVF pregnancies. However, both IVF and ultrasound-indicated screening strategies fall within contemporary willingness-to-pay thresholds, suggesting that both strategies may be appropriate to apply in clinical practice. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
比较四种经阴道超声筛查策略在单胎妊娠前置帆状胎盘产前诊断中的决策和成本效益分析。
建立了一种决策分析模型，比较了前置帆状胎盘的筛查策略。将已发表的概率和成本应用于四种经阴道超声筛查方案中，这些方案在中孕期超声检查时进行：无筛查、超声指示性筛查、仅对体外受精（IVF）受孕的妊娠进行筛查和普遍筛查。超声指示性筛查被定义为在常规解剖超声扫描时，针对与前置帆状胎盘风险增加相关的以下超声发现之一，进行经阴道超声检查：胎盘位置低、边缘或帆状脐带插入或双叶或副叶胎盘。主要结果是每质量调整生命年（QALY）的成本，以美元表示。分析是从医疗保健系统的角度进行的，选择了每 QALY 愿意支付 100000 美元的意愿支付阈值。进行了单因素和多因素敏感性分析（蒙特卡罗模拟）。
该决策分析模型表明，筛查 IVF 受孕的妊娠是最具成本效益的策略，增量成本效益比（ICER）为 29186.50/QALY。超声指示性筛查是第二有效的策略，ICER 为 56096.77/QALY。这些数据对所有单因素和多因素敏感性分析都是稳健的。
在基线假设下，经阴道超声筛查前置帆状胎盘在 IVF 妊娠中似乎最具成本效益。然而，IVF 和超声指示性筛查策略都在当代意愿支付阈值范围内，这表明这两种策略在临床实践中都可能适用。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
