title: Cost-effectiveness of diagnostic testing strategies including cervical-length measurement and fibronectin testing in women with symptoms of preterm labor.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of combining cervical-length (CL) measurement and fetal fibronectin (fFN) testing in women with symptoms of preterm labor between 24 and 34 weeks' gestation.
  
  
  METHODS
  This was a model-based cost-effectiveness analysis evaluating seven test-treatment strategies based on CL measurement and/or fFN testing in women with symptoms of preterm labor from a societal perspective, in which neonatal outcomes and costs were weighted. Estimates of disease prevalence, test accuracy and costs were based on two recently performed nationwide cohort studies in The Netherlands.
  
  
  RESULTS
  Strategies using fFN testing and CL measurement separately to predict preterm delivery are associated with higher costs and incidence of adverse neonatal outcomes compared with strategies that combine both tests. Additional fFN testing when CL is 15-30 mm was considered cost effective, leading to a cost saving of €3919 per woman when compared with a treat-all strategy, with a small deterioration in neonatal health outcomes, namely one additional perinatal death and 21 adverse outcomes per 10 000 women with signs of preterm labor (incremental cost-effectiveness ratios €39 million and €1.9 million, respectively). Implementing this strategy in The Netherlands, a country with about 180 000 deliveries annually, could lead to an annual cost saving of between €2.4 million and €7.6 million, with only a small deterioration in neonatal health outcomes.
  
  
  CONCLUSIONS
  In women with symptoms of preterm labor at 24-34 weeks' gestation, performing additional fFN testing when CL is between 15 and 30 mm is a viable and cost-saving strategy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: G-J
authors.initials: GJ
authors.lastname: van Baaren
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J Y
authors.initials: JY
authors.lastname: Vis
authors.affiliation: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: F F
authors.initials: FF
authors.lastname: Wilms
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Kwee
authors.affiliation: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Porath
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: H C J
authors.initials: HCJ
authors.lastname: Scheepers
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: M E A
authors.initials: MEA
authors.lastname: Spaanderman
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: K W M
authors.initials: KWM
authors.lastname: Bloemenkamp
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Haak
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bax
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: J M J
authors.initials: JMJ
authors.lastname: Cornette
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.affiliation: Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: B W A
authors.initials: BWA
authors.lastname: Nij Bijvanck
authors.affiliation: Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Eyck
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M T M
authors.initials: MTM
authors.lastname: Franssen
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Sollie
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: F P H A
authors.initials: FPHA
authors.lastname: Vandenbussche
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Woiski
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Bolte
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J A M
authors.initials: JAM
authors.lastname: van der Post
authors.affiliation: Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: P M M
authors.initials: PMM
authors.lastname: Bossuyt
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Department of Obstetrics and Gynecology, The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: B W J
authors.initials: BWJ
authors.lastname: Mol
mesh_terms: D054791:Cervical Length Measurement / Q000191:economics*; D002584:Cervix Uteri / Q000737:chemistry*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005353:Fibronectins / Q000032:analysis*; D005865:Gestational Age; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands; D007752:Obstetric Labor, Premature / Q000175:diagnosis / Q000191:economics*; D011237:Predictive Value of Tests; D011247:Pregnancy
chemical_list: D005353:Fibronectins
keywords: cervical length; economic evaluation; fetal fibronectin; preterm labor