Khaikin Y, Gladstone R A, Murphy K E, Melamed N, Pechlivanoglou P
Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Ultrasound Obstet Gynecol. 2025 Sep;66(3):290-297. doi: 10.1002/uog.29287. Epub 2025 Jul 10.
The purpose of this cost-utility analysis was to model the clinical and economic impact of three cervical-length screening strategies among low-risk twin pregnancies: two-step universal screening (at 18-20 and 20-22 weeks), one-step universal screening (at 18-20 weeks) and no screening.
This study used a decision-analytic model (decision tree and cohort state transition model) with a 100-year time horizon in a Canadian context. The population included dichorionic diamniotic twin pregnancies without a history of preterm birth or prophylactic progesterone or cerclage. The model assumed that vaginal progesterone was initiated for cervical length ≤ 25 mm and that cervical cerclage was performed plus vaginal progesterone treatment for cervical length ≤ 15mm. The primary outcomes were total lifetime health-related costs (in 2023 Canadian dollars ($)), quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios. Clinical outcomes included the probability of preterm birth (≤ 28 and ≤ 34 weeks), probability of stillbirth and life expectancy. Probabilistic and deterministic sensitivity analyses were carried out.
Base-case and probabilistic sensitivity analysis showed that, when compared with no screening, the two-step screening strategy increased the QALYs modestly (0.62 (95% credible interval (CrI), -0.16 to 1.41)) and decreased lifetime costs (-$2460 (95% CrI, -$4850 to $251)) by reducing the rate of preterm birth. The one-step screening strategy, although inferior to the two-step screening strategy, also increased the QALYs and reduced costs. Findings consistent with these were obtained on testing of the model assumptions with deterministic sensitivity analysis.
This cost-utility analysis supports a universal two-step screening strategy for twin pregnancies in a Canadian context. Although the conclusions of this analysis are robust in terms of the sensitivity analysis, more reliable predictions of long-term costs and quality of life require more twin-specific lifetime data. Additionally, cost-utility analyses in other healthcare contexts are needed. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
本成本效用分析的目的是模拟三种宫颈长度筛查策略对低风险双胎妊娠的临床和经济影响：两步法通用筛查（在18 - 20周和20 - 22周）、一步法通用筛查（在18 - 20周）和不进行筛查。
本研究在加拿大背景下使用了一个决策分析模型（决策树和队列状态转换模型），时间跨度为100年。研究人群包括无早产史、未使用预防性孕酮或宫颈环扎术的双绒毛膜双羊膜囊双胎妊娠。该模型假设，宫颈长度≤25mm时开始使用阴道孕酮，宫颈长度≤15mm时进行宫颈环扎术并加用阴道孕酮治疗。主要结局为终身健康相关成本（以2023年加拿大元计）、质量调整生命年（QALY）和增量成本效益比。临床结局包括早产（≤28周和≤34周）的概率、死产概率和预期寿命。进行了概率性和确定性敏感性分析。
基础病例和概率性敏感性分析表明，与不进行筛查相比，两步法筛查策略通过降低早产率适度增加了QALY（0.62（95%可信区间（CrI），-0.16至1.41））并降低了终身成本（-2460加元（95%CrI，-4850至251加元））。一步法筛查策略虽然不如两步法筛查策略，但也增加了QALY并降低了成本。通过确定性敏感性分析对模型假设进行检验时也得到了与这些结果一致的发现。
本成本效用分析支持在加拿大背景下对双胎妊娠采用通用的两步法筛查策略。尽管该分析的结论在敏感性分析方面较为稳健，但要更可靠地预测长期成本和生活质量需要更多双胎特异性的终身数据。此外，还需要在其他医疗环境中进行成本效用分析。© 2025作者。《超声妇产科》由约翰·威利父子有限公司代表国际妇产科超声学会出版。
