723: The cost-effectiveness of transvaginal cervical length screening for preterm delivery in nulliparous African American women

Abstract

African American women have higher rates of preterm birth, with recent data finding a 2.8 fold increased risk for cervical lengths ≤ 25mm on mid trimester screening. The purpose of our study was to determine the cost-effectiveness of transvaginal cervical length (TVCL) screening for the prediction of spontaneous pre-term delivery in African American women. We built a decision-analytic model using TreeAge Pro and incorporated probabilities, costs, and utilities from the literature. We compared a strategy of TVCL screening among African American nulliparous women starting with a 19-week ultrasound versus standard care for singletons without prior birth, and applied this model to a theoretical cohort of 100,000 women. We set a cost threshold of $100,000 per quality adjusted life year (QALY). The robustness of the model was assessed using sensitivity analyses. We assumed that women with a TVCL ≤20mm were prescribed vaginal progesterone, and continued surveillance. A TVCL between 20-24mm resulted in increased surveillance and possible vaginal progesterone administration. In our model, screening nulliparous African American women was associated with 3 fewer cases of cerebral palsy, 9 fewer perinatal deaths and a cost savings of $8,834,847. Baseline assumptions in the model demonstrated screening was the cost-effective strategy. In the sensitivity analysis, cost-effectiveness persisted down to a vaginal progesterone efficacy of 20%. Additionally, screening nulliparous African Americans remained the cost-effective strategy up to a pre-term delivery rate of 1.82 above baseline with a cervical length ≤20mm. TVCL screening and the use of vaginal progesterone is cost-effective in nulliparous African American women when compared to routine care in singleton nulliparous women. With the low threshold efficacy of progesterone effectiveness required, providers may wish to consider TVCL screening and progesterone prophylaxis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)