PIH7 Cost-Effectiveness of a Proteomic Test for Preterm Birth Prediction

Abstract

Preterm birth (PTB) carries increased risk of health problems for infants as well as higher healthcare costs for both infants and mothers. We evaluated the cost-effectiveness of a risk-screening-and-treat strategy, compared to usual care, for a population of commercially-insured pregnant US women without known risk factors for PTB. The strategy included a novel PTB prognostic test (PreTRM®) in the 19th-20th week of pregnancy and treatment with vaginal progesterone and high-intensity case management for the remainder of the pregnancy for women assessed as high-risk. A decision-tree with Markov nodes representing 1-week cycles from week 19 of pregnancy to birth (preterm or full-term) was developed, using a payer’s perspective and time horizon from pregnancy start to 12-months post-delivery in mothers and 30-months from birth in infants. PTB rates and costs were based on real-world cohorts of >40,000 mothers and infants with birth events in 2016, as identified in administrative claims from the HealthCore Integrated Research Database®. Estimates of test performance and treatment effectiveness were derived from published literature. Uncertainty was explored via scenario, one-way, and probabilistic sensitivity analysis (PSA). In the base-case analysis, the risk-screening-and-treat strategy dominated usual care with 870 fewer PTBs (20% reduction) and $54 million less in total cost ($863 net savings per pregnant woman). Reductions were also seen for neonatal-intensive-care-unit admissions (10%), overall length-of-stay (7%), and births <32 weeks gestation (33%). Treatment effectiveness had the most influence on cost-effectiveness estimates per one-way sensitivity analysis, followed by infant care costs and test costs. The risk-screening-and-treat strategy was dominant in the majority of PSA simulations and model scenarios. Use of a novel prognostic test during pregnancy to identify women at risk of PTB combined with evidence-based treatment can reduce total costs and prevent preterm deliveries and their consequences in a representative population of commercially-insured US women.