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Wilson, Edward C. F. 
ORCID: https://orcid.org/0000-0002-8369-1577, Wastlund, David, Moraitis, Alexandros A. and Smith, Gordon C. S.
(2021)
Late pregnancy ultrasound to screen for and manage potential birth complications in nulliparous women: a cost-effectiveness and value of information analysis.
Value in Health, 24 (4).
pp. 513-521.
ISSN 1098-3015
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Abstract
Background: Fetal growth restriction is a major risk factor for stillbirth. A routine late-pregnancy ultrasound scan could help detect this, allowing intervention to reduce the risk of stillbirth. Such a scan could also detect fetal presentation and predict macrosomia. A trial powered to detect stillbirth differences would be extremely large and expensive. Objectives: It is therefore critical to know whether this would be a good investment of public research funds. The aim of this study is to estimate the cost-effectiveness of various late-pregnancy screening and management strategies based on current information and predict the return on investment from further research. Methods: Synthesis of current evidence structured into a decision model reporting expected costs, quality-adjusted life-years, and net benefit over 20 years and value-of-information analysis reporting predicted return on investment from future clinical trials. Results: Given a willingness to pay of £20 000 per quality-adjusted life-year gained, the most cost-effective strategy is a routine presentation-only scan for all women. Universal ultrasound screening for fetal size is unlikely to be cost-effective. Research exploring the cost implications of induction of labor has the greatest predicted return on investment. A randomized, controlled trial with an endpoint of stillbirth is extremely unlikely to be a value for money investment. Conclusion: Given current value-for-money thresholds in the United Kingdom, the most cost-effective strategy is to offer all pregnant women a presentation-only scan in late pregnancy. A randomized, controlled trial of screening and intervention to reduce the risk of stillbirth following universal ultrasound to detect macrosomia or fetal growth restriction is unlikely to represent a value for money investment.
| Item Type: | Article |
|---|---|
| Additional Information: | Funding/Support: This study was funded by the National Institute for Health Research Health Technology Assessment program under grant number 15/105/01. |
| Uncontrolled Keywords: | economic evaluation,pregnancy,third trimester,ultrasound,value of information analysis,health policy,public health, environmental and occupational health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2719 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Medicine and Health Sciences > Research Centres > Population Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 03 Nov 2020 01:06 |
| Last Modified: | 06 Jun 2024 15:13 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/77498 |
| DOI: | 10.1016/j.jval.2020.11.005 |
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