Use of the fetal fibronectin assay to avert unnecessary hospitalization and bedrest in patients with preterm labor symptoms: a cost analysis

Abstract

Objective: To model cost implications of the fetal fibronectin (fFN) assay in management of patients with symptoms of preterm labor based on data from a previously published multicenter trial. Study design: Data from a trial of fFN in 763 patients with symptoms of preterm birth was used to create a decision analytic model. Standard management in the trial was compared with a theoretic management plan using fFN results to guide decisions regarding hospitalization and use of bedrest. Average costs and durations of antepartum and delivery hospitalizations for patients with preterm labor were obtained from a data set of 404,466 patients delivered in California in 1993. Average bedrest costs were obtained using data from the US Bureau of Labor Statistics ($89 per day). A cost savings of $3,000 from the use of betamethasone prior to 34 weeks was assumed based on estimates from the NIH consensus conference. All patients were treated equally until fFN results were obtained. All fFN positive patients were admitted, given steroids, and discharged after an average of 2.5 days of bedrest. Results: Under baseline assumptions, theoretic management using fFN cost $3,900 per patient vs estimates of $4,820 in the trial. This resulted in savings of $919 per patient, which was robust under sensitivity analysis of all costs in the model. Conclusions: Addition of fFN management of threatened preterm labor has theoretic cost advantages when compared to existing patterns of clinical management.