856 Differences in perinatal outcomes among rural women by county composition

Abstract

OBJECTIVE:We sought to examine the cost effectiveness and outcomes associated with universal vasa previa screening during pregnancy. STUDY DESIGN: A cost-effectiveness model using TreeAge Pro 2020 software was designed to compare outcomes and costs in women who received universal vasa previa screening versus women who received no vasa previa screening during pregnancy. We used a theoretical cohort of 3,945,000, the approximate number of live births each year in the U.S. Outcomes included stillbirth, intrapartum death, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life years (QALYs) for both the woman and the neonate. Probabilities were derived from the literature, and a costeffectiveness threshold was set at $100,000/QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions. RESULTS: In our theoretical cohort, universal vasa previa screening was a cost-effective strategy. Universal screening for vasa previa resulted in 1,499 fewer cases of missed vasa previa (Table 1). Universal screening for vasa previa resulted in fewer intrapartum deaths and cases of cerebral palsy. Universal screening for vasa previa resulted in increased effectiveness and increased costs with an incremental cost-effectiveness ratio of $82,272/QALY. This was below the willingness-to-pay threshold of $100,000/QALY, making universal screening cost effective. Sensitivity analysis demonstrated that universal vasa previa screening was cost effective as long as the sensitivity of transvaginal ultrasound for detecting vasa previa was greater than 81% (Figure 1). CONCLUSION: Universal vasa previa screening during pregnancy is a cost-effective strategy and decreases the risk of adverse neonatal outcomes.