title: Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial).
abstract: OBJECTIVE
  To assess the cost-effectiveness of a cervical pessary to prevent preterm delivery in women with a multiple pregnancy.
  
  
  METHODS
  The study design comprised an economic analysis of data from a randomized clinical trial evaluating cervical pessaries (ProTWIN). Women with a multiple pregnancy were included and an economic evaluation was performed from a societal perspective. Costs were estimated between the time of randomization and 6 weeks postpartum. The prespecified subgroup of women with a cervical length (CL) < 25(th) centile (< 38 mm) was analyzed separately. The primary endpoint was poor perinatal outcome occurring up to 6 weeks postpartum. Direct medical costs and health outcomes were estimated and incremental cost-effectiveness ratios for costs to prevent one poor outcome were calculated.
  
  
  RESULTS
  Mean costs in the pessary group (n = 401) were € 21,783 vs € 21,877 in the group in which no pessary was used (n = 407) (difference, -€ 94; 95% CI, -€ 5975 to € 5609). In the prespecified subgroup of women with a CL < 38 mm we demonstrated a significant reduction in poor perinatal outcome (12% vs 29%; RR, 0.40; 95% CI, 0.19-0.83). Mean costs in the pessary group (n = 78) were € 25,141 vs € 30,577 in the no-pessary group (n = 55) (difference, -€ 5436 (95% CI, -€ 11,001 to € 1456). In women with a CL < 38 mm, pessary treatment was the dominant strategy (more effective and less costly) with a probability of 94%.
  
  
  CONCLUSIONS
  Cervical pessaries in women with a multiple pregnancy involve costs comparable to those in women without pessary treatment. However, in women with a CL < 38 mm, treatment with a cervical pessary appears to be highly cost-effective.
authors.affiliation: Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S M S
authors.initials: SM
authors.lastname: Liem
authors.forename: G J
authors.initials: GJ
authors.lastname: van Baaren
authors.forename: F M C
authors.initials: FM
authors.lastname: Delemarre
authors.forename: I M
authors.initials: IM
authors.lastname: Evers
authors.forename: G
authors.initials: G
authors.lastname: Kleiverda
authors.forename: A J
authors.initials: AJ
authors.lastname: van Loon
authors.forename: J
authors.initials: J
authors.lastname: Langenveld
authors.forename: N
authors.initials: N
authors.lastname: Schuitemaker
authors.forename: J M
authors.initials: JM
authors.lastname: Sikkema
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: M G
authors.initials: MG
authors.lastname: van Pampus
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: D J
authors.initials: DJ
authors.lastname: Bekedam
mesh_terms: D000328:Adult; D054791:Cervical Length Measurement / Q000187:drug effects; D002584:Cervix Uteri / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D018803:Models, Economic; D010570:Pessaries / Q000191:economics; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000191:economics / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics* / Q000379:methods; D016032:Randomized Controlled Trials as Topic
keywords: cost-effectiveness; pessary; poor perinatal outcome; preterm birth; randomized controlled trial