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Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France

BACKGROUND: Previous studies have showed that the early diagnosis of threatened preterm labor decreases neonatal morbidity and mortality, avoids maternal morbidity induced by antepartum bed rest and unnecessary treatment, and reduces costs. Although there are many diagnostic tests, none is clearly r...

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Detalles Bibliográficos
Autores principales: Desplanches, Thomas, Lejeune, Catherine, Cottenet, Jonathan, Sagot, Paul, Quantin, Catherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003030/
https://www.ncbi.nlm.nih.gov/pubmed/29983643
http://dx.doi.org/10.1186/s12962-018-0106-y
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author Desplanches, Thomas
Lejeune, Catherine
Cottenet, Jonathan
Sagot, Paul
Quantin, Catherine
author_facet Desplanches, Thomas
Lejeune, Catherine
Cottenet, Jonathan
Sagot, Paul
Quantin, Catherine
author_sort Desplanches, Thomas
collection PubMed
description BACKGROUND: Previous studies have showed that the early diagnosis of threatened preterm labor decreases neonatal morbidity and mortality, avoids maternal morbidity induced by antepartum bed rest and unnecessary treatment, and reduces costs. Although there are many diagnostic tests, none is clearly recommended by international guidelines. The aim of our study was to compare seven diagnostic methods in terms of effectiveness and cost using a decision analysis model in singleton pregnancy presenting threatened preterm labor, between 24 and 34 weeks of gestation. METHODS: Seven diagnostic strategies based on individual or combined use of the following tests: cervical length, cervical fibronectin test, cervical interleukin test and protein in maternal serum, were compared using a decision analysis model. Effectiveness was expressed in terms of serious adverse neonatal events avoided (neonatal morbidity and mortality) at the hospital discharge. The economic analysis was performed from the health care system perspective. Deterministic and probabilistic analyses were performed to test the robustness of the model. RESULTS: At 24–34 weeks of gestation, the association of cervical length and qualitative fibronectin was the most efficient strategy dominating all alternatives, reducing the perinatal death or severe neonatal morbidity rate up to 15% and the costs up to 31% according to the gestational age. This result was confirmed by the deterministic sensitivity analyses. The probabilistic analysis showed that the association of cervical length and qualitative fibronectin dominated cervical length < 15 mm in more than 90% of the simulations. The comparison with the other tests revealed more uncertainty. CONCLUSIONS: A test using cervical length and qualitative fetal fibronectin appears to be the best diagnostic strategy. Decisions regarding its generalization and funding in France in this population of women should take into account the high, lifetime costs induced by prematurity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12962-018-0106-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-60030302018-07-06 Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France Desplanches, Thomas Lejeune, Catherine Cottenet, Jonathan Sagot, Paul Quantin, Catherine Cost Eff Resour Alloc Research BACKGROUND: Previous studies have showed that the early diagnosis of threatened preterm labor decreases neonatal morbidity and mortality, avoids maternal morbidity induced by antepartum bed rest and unnecessary treatment, and reduces costs. Although there are many diagnostic tests, none is clearly recommended by international guidelines. The aim of our study was to compare seven diagnostic methods in terms of effectiveness and cost using a decision analysis model in singleton pregnancy presenting threatened preterm labor, between 24 and 34 weeks of gestation. METHODS: Seven diagnostic strategies based on individual or combined use of the following tests: cervical length, cervical fibronectin test, cervical interleukin test and protein in maternal serum, were compared using a decision analysis model. Effectiveness was expressed in terms of serious adverse neonatal events avoided (neonatal morbidity and mortality) at the hospital discharge. The economic analysis was performed from the health care system perspective. Deterministic and probabilistic analyses were performed to test the robustness of the model. RESULTS: At 24–34 weeks of gestation, the association of cervical length and qualitative fibronectin was the most efficient strategy dominating all alternatives, reducing the perinatal death or severe neonatal morbidity rate up to 15% and the costs up to 31% according to the gestational age. This result was confirmed by the deterministic sensitivity analyses. The probabilistic analysis showed that the association of cervical length and qualitative fibronectin dominated cervical length < 15 mm in more than 90% of the simulations. The comparison with the other tests revealed more uncertainty. CONCLUSIONS: A test using cervical length and qualitative fetal fibronectin appears to be the best diagnostic strategy. Decisions regarding its generalization and funding in France in this population of women should take into account the high, lifetime costs induced by prematurity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12962-018-0106-y) contains supplementary material, which is available to authorized users. BioMed Central 2018-06-14 /pmc/articles/PMC6003030/ /pubmed/29983643 http://dx.doi.org/10.1186/s12962-018-0106-y Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Desplanches, Thomas
Lejeune, Catherine
Cottenet, Jonathan
Sagot, Paul
Quantin, Catherine
Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France
title Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France
title_full Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France
title_fullStr Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France
title_full_unstemmed Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France
title_short Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France
title_sort cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in france
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003030/
https://www.ncbi.nlm.nih.gov/pubmed/29983643
http://dx.doi.org/10.1186/s12962-018-0106-y
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