Late pregnancy ultrasound to screen for and manage potential birth complications in nulliparous women: a cost-effectiveness and value of information analysis

Wilson, Edward C. F., 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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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
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Depositing User: LivePure Connector
Date Deposited: 03 Nov 2020 01:06
Last Modified: 11 Apr 2022 13:30
DOI: 10.1016/j.jval.2020.11.005

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