Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial).

Abstract

OBJECTIVE:

To assess the cost-effectiveness of a cervical pessary to prevent preterm delivery in women with a multiple pregnancy.

METHODS:

The study design comprised an economic analysis of data from a randomized clinical trial evaluating cervical pessaries (ProTWIN). Women with a multiple pregnancy were included and an economic evaluation was performed from a societal perspective. Costs were estimated between the time of randomization and 6 weeks postpartum. The prespecified subgroup of women with a cervical length (CL) < 25(th) centile (< 38 mm) was analyzed separately. The primary endpoint was poor perinatal outcome occurring up to 6 weeks postpartum. Direct medical costs and health outcomes were estimated and incremental cost-effectiveness ratios for costs to prevent one poor outcome were calculated.

RESULTS:

Mean costs in the pessary group (n = 401) were € 21,783 vs € 21,877 in the group in which no pessary was used (n = 407) (difference, -€ 94; 95% CI, -€ 5975 to € 5609). In the prespecified subgroup of women with a CL < 38 mm we demonstrated a significant reduction in poor perinatal outcome (12% vs 29%; RR, 0.40; 95% CI, 0.19-0.83). Mean costs in the pessary group (n = 78) were € 25,141 vs € 30,577 in the no-pessary group (n = 55) (difference, -€ 5436 (95% CI, -€ 11,001 to € 1456). In women with a CL < 38 mm, pessary treatment was the dominant strategy (more effective and less costly) with a probability of 94%.

CONCLUSION:

Cervical pessaries in women with a multiple pregnancy involve costs comparable to those in women without pessary treatment. However, in women with a CL < 38 mm, treatment with a cervical pessary appears to be highly cost-effective.

• Authors: S M S Liem, G J van Baaren, F M C Delemarre, I M Evers, G Kleiverda, A J van Loon, J Langenveld, N Schuitemaker, J M Sikkema, B C Opmeer, M G van Pampus, B W J Mol, D J Bekedam
• Journal: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (Ultrasound Obstet Gynecol) Vol. 44 Issue 3 Pg. 338-45 (Sep 2014) ISSN: 1469-0705 [Electronic] England
• PMID: 24898103 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Topics

• Adult
• Cervical Length Measurement (drug effects)
• Cervix Uteri (drug effects)
• Cost-Benefit Analysis
• Female
• Humans
• Models, Economic
• Pessaries (economics)
• Pregnancy
• Pregnancy Outcome
• Pregnancy, Multiple
• Premature Birth (economics, prevention & control)
• Prenatal Care (economics, methods)
• Randomized Controlled Trials as Topic