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The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis

Wastlund, David; Moraitis, Alexandros A.; Thornton, Jim G.; Sanders, Julia; White, Ian R.; Brocklehurst, Peter; Smith, Gordon C.S.; Wilson, Edward C.F.; Wastlund, David

The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis Thumbnail


Authors

David Wastlund

Alexandros A. Moraitis

Jim G. Thornton

Julia Sanders

Ian R. White

Peter Brocklehurst

Gordon C.S. Smith

Edward C.F. Wilson

David Wastlund



Abstract

Objective
To identify the most cost‐effective policy for detection and management of fetal macrosomia in late‐stage pregnancy.

Design
Health economic simulation model.

Setting
All English NHS antenatal services.

Population
Nulliparous women in the third trimester treated within the UK NHS.

Methods
A health economic simulation model was used to compare long‐term maternal–fetal health and cost outcomes for two detection strategies (universal ultrasound scanning at approximately 36 weeks of gestation versus selective ultrasound scanning), combined with three management strategies (planned caesarean section versus induction of labour versus expectant management) of suspected fetal macrosomia. Probabilities, costs and health outcomes were taken from literature.

Main outcome measures
Expected costs to the NHS and quality‐adjusted life‐years (QALYs) gained from each strategy, calculation of net benefit and hence identification of most cost‐effective strategy.

Results
Compared with selective ultrasound, universal ultrasound increased QALYs by 0.0038 (95% CI 0.0012–0.0076), but also costs by £123.50 (95% CI 99.6–149.9). Overall, the health gains were too small to justify the cost increase given current UK thresholds cost‐effective policy was selective ultrasound coupled with induction of labour where macrosomia was suspected.

Conclusions
The most cost‐effective policy for detection and management of fetal macrosomia is selective ultrasound scanning coupled with induction of labour for all suspected cases of macrosomia. Universal ultrasound scanning for macrosomia in late‐stage pregnancy is not cost‐effective.

Tweetable abstract
Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted.

Citation

Wastlund, D., Moraitis, A. A., Thornton, J. G., Sanders, J., White, I. R., Brocklehurst, P., …Wastlund, D. (2019). The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis. BJOG: An International Journal of Obstetrics and Gynaecology, 126(10), 1243-1250. https://doi.org/10.1111/1471-0528.15809

Journal Article Type Article
Acceptance Date Apr 16, 2019
Online Publication Date May 8, 2019
Publication Date 2019-09
Deposit Date Apr 25, 2019
Publicly Available Date May 9, 2020
Journal BJOG: An International Journal of Obstetrics & Gynaecology
Print ISSN 1470-0328
Electronic ISSN 1471-0528
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 126
Issue 10
Pages 1243-1250
DOI https://doi.org/10.1111/1471-0528.15809
Public URL https://nottingham-repository.worktribe.com/output/1841635
Publisher URL https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15809

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