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

Wilson, Ed, Wastlund, David, Moraitis, Alexandros and Smith, Gordon C. S. (2020) 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. ISSN 1098-3015 (In Press)

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Abstract

Background: Foetal growth restriction (FGR) 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 foetal presentation and predict macrosomia. A trial powered to detect stillbirth differences would be extremely large and expensive. It is therefore critical to know whether this would be a good investment of public research funds. Objective: 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, QALYs 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 QALY gained, the most cost-effective strategy is a routine presentation-only scan for all women. Universal ultrasound screening for foetal size is unlikely to be cost-effective. Research exploring the cost implications of induction of labour has the greatest predicted return on investment. A randomised controlled trial with an endpoint of stillbirth is extremely unlikely to be a value for money investment. Conclusion: Given current UK value-for-money thresholds, the most cost-effective strategy is to offer all pregnant women a presentation-only scan in late pregnancy. A randomised controlled trial of screening and intervention to reduce the risk of stillbirth following universal ultrasound to detect macrosomia or FGR is unlikely to represent a value for money investment.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 03 Nov 2020 01:06
Last Modified: 03 Nov 2020 01:06
URI: https://ueaeprints.uea.ac.uk/id/eprint/77498
DOI:

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