Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis.
OBJECTIVE
The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity.


METHODS
We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years, cost in US dollars, and number of preterm births prevented.


RESULTS
Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and was the dominant choice over the 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 alpha-hydroxyprogesterone caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1339 ($8325 vs $9664), when compared with treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the United States.


CONCLUSIONS
Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears to be cost-effective and yields the greatest reduction in preterm birth at <34 weeks' gestation.
Cahill
Alison G
AG
Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA.
Odibo
Anthony O
AO
Caughey
Aaron B
AB
Stamilio
David M
DM
Hassan
Sonia S
SS
Macones
George A
GA
Romero
Roberto
R
D000282:Administration, Intravaginal; D054791:Cervical Length Measurement / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000191:economics; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics* / Q000517:prevention & control*; D011374:Progesterone / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D014481:United States
D011372:Progestins; D011374:Progesterone