title: Evaluating the cost-effectiveness of prenatal surgery for myelomeningocele: a decision analysis.
abstract: OBJECTIVE
  To determine whether prenatal myelomeningocele repair is a cost-effective strategy compared to postnatal repair.
  
  
  METHODS
  Decision-analysis modeling was used to calculate the cumulative costs, effects and incremental cost-effectiveness ratio of prenatal myelomeningocele repair compared with postnatal repair in singleton gestations with a normal karyotype that were identified with myelomeningocele between T1 and S1. The model accounted for costs and quality-adjusted life years (QALYs) in three populations: (1) myelomeningocele patients; (2) mothers carrying myelomeningocele patients; and (3) possible future siblings of these patients. Sensitivity analysis was performed using one-way, two-way and Monte Carlo simulations.
  
  
  RESULTS
  Prenatal myelomeningocele repair saves $ 2 066 778 per 100 cases repaired. Additionally, prenatal surgery results in 98 QALYs gained per 100 repairs with 42 fewer neonates requiring shunts and 21 fewer neonates requiring long-term medical care per 100 repairs. However, these benefits are coupled to 26 additional cases of uterine rupture or dehiscence and one additional case of neurologic deficits in future offspring per 100 repairs. Results were robust in sensitivity analysis.
  
  
  CONCLUSIONS
  Prenatal myelomeningocele repair is cost effective and frequently cost saving compared with postnatal myelomeningocele repair despite the increased likelihood of maternal and future pregnancy complications associated with prenatal surgery.
authors.affiliation: Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. ewerner4@jhmi.edu
authors.forename: E F
authors.initials: EF
authors.lastname: Werner
authors.forename: C S
authors.initials: CS
authors.lastname: Han
authors.forename: I
authors.initials: I
authors.lastname: Burd
authors.forename: H S
authors.initials: HS
authors.lastname: Lipkind
authors.forename: J A
authors.initials: JA
authors.lastname: Copel
authors.forename: M O
authors.initials: MO
authors.lastname: Bahtiyar
authors.forename: S F
authors.initials: SF
authors.lastname: Thung
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000191:economics / Q000601:surgery*; D013513:Obstetric Surgical Procedures / Q000191:economics*; D011247:Pregnancy; D013997:Time Factors