title: Implementation of foetal fibronectin testing: Admissions, maternal interventions and costs at 1 year.
abstract: Foetal fibronectin testing (fFN) has a high negative predictive value for preterm delivery, but it has a cost implication. This two-stage prospective study evaluated the real patient costs and clinical impact of introducing the fFN test in women presenting acutely with threatened preterm labour in a tertiary UK obstetric hospital. Introduction of the fFN test for women with threatened preterm labour reduced antenatal admissions and in utero transfers, and reduced steroid treatment and tocolysis, even at 1 year after implementation. The total number of bed days for women with threatened preterm labour who did not deliver during admission fell from 132 (mean 8.8 days) to 25 days (mean 3.6 days). The mean cost of admission per woman before introduction of the fFN test was £1032 (95% CI £880 to £1184); after it was £339 (95% CI £261 to £417). In this small single centre study, the introduction of the test produced a cost saving of £693 per woman (95% CI, £464 to £922) which over 12 months potentially saves £74844 (95% CI £50,112 to £99,576). Further studies are needed to formally evaluate the cost-effectiveness of the fFN test and its impact on clinical decision-making in large populations.
authors.affiliation: a Department of Obstetrics and Gynaecology , Homerton University Hospital , London , UK.
authors.forename: Maryam
authors.initials: M
authors.lastname: Parisaei
authors.affiliation: b UCL Institute for Women's Health, EGA and Obstetric Wing , University College London Hospital , London , UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Currie
authors.affiliation: b UCL Institute for Women's Health, EGA and Obstetric Wing , University College London Hospital , London , UK.
authors.forename: Neil
authors.initials: N
authors.lastname: O'Gorman
authors.affiliation: c UCL Department of Applied Health Research , London , UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: b UCL Institute for Women's Health, EGA and Obstetric Wing , University College London Hospital , London , UK.
authors.forename: Anna L
authors.initials: AL
authors.lastname: David
mesh_terms: D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D002584:Cervix Uteri / Q000378:metabolism; D003362:Cost-Benefit Analysis; D061827:Dimensional Measurement Accuracy; D005260:Female; D005333:Fetus / Q000378:metabolism*; D005353:Fibronectins / Q000032:analysis / Q000378:metabolism; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007752:Obstetric Labor, Premature / Q000191:economics / Q000517:prevention & control; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000379:methods; D011296:Prenatal Diagnosis / Q000191:economics / Q000379:methods; D015397:Program Evaluation; D015203:Reproducibility of Results; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D005353:Fibronectins
keywords: Foetal fibronectin test; cost effectiveness; spontaneous preterm birth; threatened preterm labour