title: Placental alpha-microglobulin-1 and combined traditional diagnostic test: a cost-benefit analysis.
abstract: OBJECTIVE
  We sought to evaluate if the placental alpha-microglobulin (PAMG)-1 test vs the combined traditional diagnostic test (CTDT) of pooling, nitrazine, and ferning would be a cost-beneficial screening strategy in the setting of potential preterm premature rupture of membranes.
  
  
  METHODS
  A decision analysis model was used to estimate the economic impact of PAMG-1 test vs the CTDT on preterm delivery costs from a societal perspective. Our primary outcome was the annual net cost-benefit per person tested. Baseline probabilities and costs assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2013 US dollars.
  
  
  RESULTS
  Annual net benefit from PAMG-1 was $20,014 per person tested, while CTDT had a net benefit of $15,757 per person tested. If the probability of rupture is <38%, PAMG-1 will be cost-beneficial with an annual net benefit of $16,000-37,000 per person tested, while CTDT will have an annual net benefit of $16,000-19,500 per person tested. If the probability of rupture is >38%, CTDT is more cost-beneficial. Monte Carlo simulations of 1 million trials selected PAMG-1 as the optimal strategy with a frequency of 89%, while CTDT was only selected as the optimal strategy with a frequency of 11%. Sensitivity analyses were robust.
  
  
  CONCLUSIONS
  Our cost-benefit analysis provides the economic evidence for the adoption of PAMG-1 in diagnosing preterm premature rupture of membranes in uncertain presentations and when CTDT is equivocal at 34 to <37 weeks' gestation.
authors: Department of Obstetrics and Gynecology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY. Electronic address: nelsonechebiri@gmail.com.
authors: Nelson C
authors: NC
authors: Echebiri
authors: Social Science Research Center, Mississippi State University, Starkville, MS; Department of Global Health and Population, Harvard School of Public Health, Boston, MA.
authors: M Maya
authors: MM
authors: McDoom
authors: Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK.
authors: Jessica A
authors: JA
authors: Pullen
authors: Department of Obstetrics and Gynecology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
authors: Meaghan M
authors: MM
authors: Aalto
authors: Department of Obstetrics and Gynecology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
authors: Natasha N
authors: NN
authors: Patel
authors: Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK.
authors: Nora M
authors: NM
authors: Doyle
mesh_terms: D000510:Alpha-Globulins / Q000032:analysis*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000191:economics; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis*; D006801:Humans; D010920:Placenta / Q000737:chemistry*; D011247:Pregnancy
chemical_list: D000510:Alpha-Globulins; C016001:alpha-1-microglobulin
keywords: AmniSure; decision analysis; premature ruptures of membrane; preterm premature ruptures of membrane