title: Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
mesh_terms: 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
chemical_list: D011372:Progestins; D011374:Progesterone