title: Cost-effectiveness of transabdominal ultrasound for cervical length screening for preterm birth prevention.
abstract: OBJECTIVE
  Transabdominal ultrasound (TAUS) cervical length (CL) screening has been proposed as an alternative to universal transvaginal screening to identify women at an increased risk of preterm birth. We sought to identify whether and under what circumstances TAUS would be cost-effective.
  
  
  METHODS
  This is a decision analytic model designed to compare an initial TAUS CL screening approach with universal transvaginal screening in a hypothetical cohort of women with a singleton pregnancy. Cost, probability, and utility estimates were derived from the existing literature.
  
  
  RESULTS
  Under baseline assumptions, universal transvaginal was the dominant strategy. In comparison to TAUS, universal transvaginal CL screening reduced preterm birth by 0.03%, reduced costs by $1.2 million and increased quality-adjusted life years by 70 per 100,000 women. Although robust to many changes in many estimates, the model was sensitive to the cost of a transvaginal ultrasound, the prevalence of a short cervix and the test characteristics (ie, sensitivity and specificity) of a TAUS screening examination for short CL.
  
  
  CONCLUSIONS
  Compared with an initial TAUS screen, universal transvaginal ultrasound was a more cost-effective strategy under most assumptions. Optimizing TAUS testing characteristics or applying a transabdominal screening strategy in lower risk populations may yield an initial TAUS to be cost-effective.
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Emily S
authors: ES
authors: Miller
authors: William A
authors: WA
authors: Grobman
mesh_terms: D054791:Cervical Length Measurement / Q000191:economics* / Q000379:methods; D002584:Cervix Uteri / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011336:Probability; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity
keywords: cervical length; preterm birth; screening; ultrasound