Journal article
Impact of maternal obesity on fetal cardiac screening: which follow-up strategy is cost-effective?
Ultrasound in obstetrics & gynecology, Vol.56(5), pp.705-716
11/01/2020
DOI: 10.1002/uog.21895
PMID: 31614030
Abstract
Objective To perform a cost-effectiveness analysis of different follow-up strategies for non-obese and obese women who had incomplete fetal cardiac screening for major congenital heart disease (CHD).
Methods Three decision-analytic models, one each for non-obese, obese and Class-III-obese women, were developed to compare five follow-up strategies for initial suboptimal fetal cardiac screening. The five strategies were: (1) no follow-up ultrasound (US) examination but direct referral to fetal echocardiography (FE); (2) one follow-up US, then FE if fetal cardiac views were still suboptimal; (3) up to two follow-up US, then FE if fetal cardiac views were still suboptimal; (4) one follow-up US and no FE; and (5) up to two follow-up US and no FE. The models were designed to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. A cost-effectiveness willingness-to-pay threshold was set at US$100 000 per quality-adjusted life year (QALY). Base-case and sensitivity analysis and Monte-Carlo simulation were performed.
Results In our base-case models for all body mass index (BMI) groups, no follow-up US, but direct referral to FE led to the best outcomes, detecting 7%, 25% and 82% more fetuses with CHD in non-obese, obese and Class-III-obese women, respectively, compared with the baseline strategy of one follow-up US and no FE. However, no follow-up US, but direct referral to FE was above the US$100 000/QALY threshold and therefore not cost-effective. The cost-effective strategy for all BMI groups was one follow-up US and no FE. Both up to two follow-up US with no FE and up to two follow-up US with FE were dominated (being more costly and less effective), while one follow-up US with FE was over the cost-effectiveness threshold. One follow-up US and no FE was the optimal strategy in 97%, 93% and 86% of trials in Monte-Carlo simulation for non-obese, obese and Class-III-obese models, respectively.
Conclusion For both non-obese and obese women with incomplete fetal cardiac screening, the optimal CHD follow-up screening strategy is no further US and immediate referral to FE; however, this strategy is not cost-effective. Considering costs, one follow-up US and no FE is the preferred strategy. For both obese and non-obese women, Monte-Carlo simulations showed clearly that one follow-up US and no FE was the optimal strategy.
Details
- Title: Subtitle
- Impact of maternal obesity on fetal cardiac screening: which follow-up strategy is cost-effective?
- Creators
- G. S. Bak - Odense University HospitalB. L. Shaffer - Oregon Health & Science UniversityE. Madriago - Oregon Health & Science UniversityA. Allen - Oregon Health & Science UniversityB. Kelly - Oregon Health & Science UniversityA. B. Caughey - Oregon Health & Science UniversityL. Pereira - Oregon Health & Science University
- Resource Type
- Journal article
- Publication Details
- Ultrasound in obstetrics & gynecology, Vol.56(5), pp.705-716
- DOI
- 10.1002/uog.21895
- PMID
- 31614030
- NLM abbreviation
- Ultrasound Obstet Gynecol
- ISSN
- 0960-7692
- eISSN
- 1469-0705
- Publisher
- Wiley
- Number of pages
- 12
- Language
- English
- Date published
- 11/01/2020
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984848506202771
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