David Wastlund
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
Authors
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., Smith, G. C., Wilson, E. C., & 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 |
Contract Date | Apr 25, 2019 |
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The cost-effectiveness of universal late-pregnancy
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Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/
Appendix
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Tables 3+4
(535 Kb)
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The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision-analysis
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