title: Placental Alpha-Microglobulin-1 Test in Resource-Limited Settings: A Cost-Effectiveness Analysis.
abstract: OBJECTIVE
  To evaluate whether the use of placental alpha-microglobulin-1 (PAMG-1) for the diagnosis of preterm premature rupture of membranes is cost-effective in resource-limited settings.
  
  
  METHODS
  We designed a decision-analytic model from a third-party payer's perspective to determine the cost-effectiveness of the PAMG-1 test compared with the traditional diagnostic test of pooling, Nitrazine, and ferning in diagnosing preterm premature rupture of membranes in a resource-limited setting. The primary health outcome of interest is the number of hospital transfers averted by each strategy per 1,000 patients screened. Baseline probabilities and cost assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2015 U.S. dollars.
  
  
  RESULTS
  Under our baseline parameters, the use of a PAMG-1 test was the preferred cost-effective strategy. The PAMG-1 test averted hospital transfers of 447 true-negative patients per 1,000 tested at a cost of $143,407 ($320.82 per hospital transfer averted). The traditional test averted hospital transfers of 395 true-negative patients per 1,000 tested at a cost of $172,652 ($437.40 per hospital transfer averted). In a Monte Carlo simulation of 10 million trials, the PAMG-1 test was selected as the most cost-effective strategy with a frequency of 74%. The traditional test was only selected with a frequency of 26%. The "do-nothing" strategy was not selected throughout the trial.
  
  
  CONCLUSIONS
  Among women presenting at resource-limited settings with a history suspicious of preterm premature rupture of membranes between 24 and 36 weeks of gestation, our analysis provides evidence suggesting that PAMG-1 is the most cost-effective testing strategy.
authors: Department of Obstetrics and Gynecology, Meritus Health, Hagerstown, Maryland; the Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida; the Department of Obstetrics and Gynecology, University at Buffalo, Buffalo, New York; the Social Science Research Center, Mississippi State University, Starkville, Mississippi; and the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors: Nelson C
authors: NC
authors: Echebiri
authors: Rachel G
authors: RG
authors: Sinkey
authors: Jamie L
authors: JL
authors: Szczepanski
authors: James A
authors: JA
authors: Shelton
authors: M Maya
authors: MM
authors: McDoom
authors: Anthony O
authors: AO
authors: Odibo
mesh_terms: D015415:Biomarkers / Q000032:analysis; D003362:Cost-Benefit Analysis; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis*; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000032:analysis / Q000191:economics*; D011247:Pregnancy
chemical_list: D015415:Biomarkers; C032231:IGFBP1 protein, human; D018970:Insulin-Like Growth Factor Binding Protein 1