Cost‐effectiveness of cervical length screening and progesterone treatment to prevent spontaneous preterm delivery in Sweden

Abstract

What are the novel findings of this work?This is the first study to estimate the cost-effectiveness of cervical length (CL) screening by transvaginal ultrasound and vaginal progesterone treatment in the case of a short cervix in a healthcare context different from that in the USA. All interventions to prevent spontaneous preterm delivery had better health outcomes compared with no screening. What are the clinical implications of this work?CL screening and vaginal progesterone treatment may be cost-effective in the Swedish healthcare context. Ideally, each country should perform its own cost-effectiveness analysis considering the conditions unique to their healthcare system and population.

ISUOG Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan

“…Meta-analyses of randomized controlled trials of women with singleton gestation, no prior spontaneous preterm birth and transvaginal sonographic CL < 25 mm before 24 weeks have shown that administration of vaginal progesterone significantly decreases the risk of preterm birth and neonatal morbidity [99][100][101] . Two cost-effectiveness analyses have shown that measurement of CL in the mid trimester and progesterone supplementation in women with a short cervix appears to be a cost-effective screening strategy for preterm birth 102,103 . For these reasons, transvaginal ultrasound CL measurement is commonly recommended in the general population [104][105][106] .…”

ISUOG Practice Guidelines: role of ultrasound in the prediction of spontaneous preterm birth

“…Whether implementation of contingent or universal CL screening should be recommended generally remains a matter of debate. Although a (probably overestimated) increment of $175 million in healthcare expenditure per year has been calculated for the introduction of universal CL screening in the USA 74 , several publications attest the cost-effectiveness of this strategy, especially because, after the identification of a short cervix in asymptomatic patients, the timely prescription of vaginal progesterone results in a reduction of PTB along with its individual-, family-and healthcare-related costs 13,14,[75][76][77][78][79] . Furthermore, contingent CL screening, limited to patients with at least one risk factor for PTB, would miss nearly 40% of women with a short cervix, who are potentially at high risk for PTB 80 .…”

Vaginal Nanoformulations for the Management of Preterm Birth

“…By example, cervical length is correlated with a high risk of PTB. Typically diagnosed by transvaginal ultrasound, cervix length of less than 25 mm midway through pregnancy is correlated with increased incidence of spontaneous PTB [ 13 , 47 , 48 , 49 ] and a criterion for consideration of therapeutic intervention. Moreover, vaginal administration of progesterone in pregnant women with short cervical lengths reduced the rate of PTB by 45% [ 50 ].…”