title: Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth.
abstract: ObjectiveThe objective of this study was to evaluate the potential impact to the U.S. health care system by adopting a novel test that identifies women at risk for spontaneous preterm birth.MethodsA decision-analytic model was developed to assess clinical and cost outcomes over a 1-year period. The use of a prognostic test to predict spontaneous preterm birth in a hypothetical population of women reflective of the U.S. population (predictive arm) was compared with the current baseline rate of spontaneous preterm birth and associated infant morbidity and mortality (baseline care arm).ResultsIn a population of 3,528,593 births, our model predicts a 23.5% reduction in infant mortality (8,300 vs. 6,343 deaths) with use of the novel test. The rate of acute conditions at birth decreased from 11.2 to 8.1%; similarly, the rate of developmental disabilities decreased from 13.2 to 11.5%. The rate of spontaneous preterm birth decreased from 9.8 to 9.1%, a reduction of 23,430 preterm births. Direct medical costs savings was $511.7M (- 2.1%) in the first year of life.DiscussionThe use of a prognostic test for reducing spontaneous preterm birth is a dominant strategy that could reduce costs and improve outcomes. More research is needed once such a test is available to determine if these results are borne out upon real-world use.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: John A F
authors.initials: JA
authors.lastname: Zupancic
authors.affiliation: Division of Perinatal Institute and Neonatology, Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: James M
authors.initials: JM
authors.lastname: Greenberg
authors.affiliation: GfK, Wayland, Massachusetts.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Garfield
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Thung
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
keywords: clinical and cost outcomes; infant morbidity; infant mortality; prenatal testing; preterm birth; progesterone; spontaneous preterm birth