title: Cost-effectiveness analysis of cervical length measurement and fibronectin testing in women with threatened preterm labor.
abstract: OBJECTIVE
  The objective of the study was to evaluate the cost-effectiveness of risk stratification with cervical length (CL) measurement and/or fetal fibronectin (fFN) tests in women with threatened preterm labor between 24 and 34 weeks' gestation.
  
  
  METHODS
  We performed a model-based cost-effectiveness analysis to evaluate 7 test-treatment strategies in women with threatened preterm labor from a health care system perspective. Estimates on disease prevalence, costs, and test accuracy were based on medical literature.
  
  
  RESULTS
  We found that additional fFN testing in the case of a CL between 10 and 30 mm is cost saving without compromising neonatal health outcomes, compared with a treat-all strategy or single CL testing. Implementing this strategy could lead to an annual cost saving between €2.8 million and €14.4 million in The Netherlands, a country with about 180,000 deliveries annually.
  
  
  CONCLUSIONS
  In women with threatened preterm labor between 24 and 34 weeks of gestation, the most cost-effective test strategy uses a combination of CL and fFN testing.
authors.affiliation: Department of Gynecology and Obstetrics, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: g.j.vanbaaren@amc.uva.nl.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: van Baaren
authors.forename: Jolande Y
authors.initials: JY
authors.lastname: Vis
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
mesh_terms: D015415:Biomarkers / Q000032:analysis; D054791:Cervical Length Measurement / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D005353:Fibronectins / Q000032:analysis*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D018803:Models, Economic; D009426:Netherlands; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000191:economics; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics / Q000517:prevention & control*; D018570:Risk Assessment / Q000191:economics*
chemical_list: D015415:Biomarkers; C403421:FFN protein, human; D005353:Fibronectins
keywords: cervical length; cost-effectiveness; economic evaluation; fibronectin; preterm labor