Cost‐effectiveness of one‐stage ultrasound screening in pregnancy: a report from the Helsinki ultrasound trial

Abstract

The objective of this study was to evaluate, in a controlled clinical trial, the costs of standardized one-stage ultrasound screening in pregnancy in relation to the reduction in perinatal mortality. A trial population of 9310 pregnant women was randomly allocated to ultrasound screening or a control group. Two obstetric hospitals and 64 recruiting antenatal health centers were involved. The costs included actually realized costs, i.e. positive costs, and gains, i.e. negative costs, resulting from lower health-care use. Cost-accounting data were obtained by a questionnaire to all attenders and measurements at the screening, and later complemented by a questionnaire to a random sample of 534 screened women. Internal accounting and other hospital data, national statistics and health-market sources were also used. The actually realized cost of each avoided perinatal death was FIM 84 378 ($21,938), while the net overall estimate combining all positive and negative costs showed a cost saving of FIM 65 680 ($17,077). The total positive unit cost of ultrasound screening was FIM 393 ($102). Longer ultrasound examination time and more numerous advanced examinations were rewarded by clearly fewer perinatal deaths and a better cost-effectiveness ratio. One-stage second-trimester ultrasound screening is cost-effective when all significant costs and effects are taken into account.

Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness

“…Even less has been reported on the financial cost to women attending for ultrasound scans. Where cost effectiveness was reported, the quality of the evidence on effectiveness was often dubious; only one economic evaluation was based on a randomised trial 10 . Longer term costs have not been explored at all.…”

“…This was much higher than the cost of any of the routine scans estimated in the costing study we carried out at Liverpool, which averaged between £14 and £16, depending on the purpose of the scan. Only three studies, however, presented data for the cost of ultrasound 10,11,20 . The average cost of a scan in these three studies was £35.42.…”

“…A cost effectiveness study was carried out alongside the Helsinki Ultrasound Trial 10 . This trial compared routine practice of normal antenatal care with a policy of normal antenatal care and one routine ultrasound scan between 16 and 20 weeks of gestation.…”

“…Summary measures of economic benefit (such as cost per perinatal death avoided) are clearly dependent on the quality of the information on effectiveness. Only one study 10 was based on a randomised trial; one other study 11 was a before -after comparison. All the other studies cited information on effectiveness from the literature and modelled their economic evaluation on this information.…”

“…of equipment), and others are average costs per woman tested. Two studies 10,20 also considered the woman's travel costs. At UK prices in 1997 these averaged between £1.43 and £16.65.…”