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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
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) < 25th 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
- Subjects
PREMATURE labor; PREMATURE infants; MULTIPLE birth; PUERPERAL disorders; MEDICAL care costs; COST effectiveness
- Publication
Ultrasound in Obstetrics & Gynecology, 2014, Vol 44, Issue 3, p338
- ISSN
0960-7692
- Publication type
Article
- DOI
10.1002/uog.13432