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- Title
Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial)
- Authors
Liem, S M S; van Baaren, G J; Delemarre, F M C; Evers, I M; Kleiverda, G; van Loon, A J; Langenveld, J; Schuitemaker, N; Sikkema, J M; Opmeer, B C; van Pampus, M G; Mol, B W J; Bekedam, D J
- 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. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
- Publication
Ultrasound in Obstetrics & Gynecology, 2014, Vol 44, Issue 3, p338
- ISSN
0960-7692
- Publication type
Journal Article
- DOI
10.1002/uog.13432