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The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision-analysis

Wastlund, David, Moraitis, Alexandros A., Thornton, Jim G., Sanders, Julia, White, Ian R., Brocklehurst, Peter, Smith, Gordon C.S. and WIlson, Edward C.F. 2019. The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision-analysis. BJOG: An International Journal of Obstetrics and Gynaecology 126 (10) , pp. 1243-1250. 10.1111/1471-0528.15809

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Abstract

Objective To identify the most cost‐effective policy for detection and management of fetal macrosomia in late‐stage pregnancy. Design Health economic simulation model. Setting All English NHS antenatal services. Population Nulliparous women in the third trimester treated within the UK NHS. Methods A health economic simulation model was used to compare long‐term maternal–fetal health and cost outcomes for two detection strategies (universal ultrasound scanning at approximately 36 weeks of gestation versus selective ultrasound scanning), combined with three management strategies (planned caesarean section versus induction of labour versus expectant management) of suspected fetal macrosomia. Probabilities, costs and health outcomes were taken from literature. Main outcome measures Expected costs to the NHS and quality‐adjusted life‐years (QALYs) gained from each strategy, calculation of net benefit and hence identification of most cost‐effective strategy. Results Compared with selective ultrasound, universal ultrasound increased QALYs by 0.0038 (95% CI 0.0012–0.0076), but also costs by £123.50 (95% CI 99.6–149.9). Overall, the health gains were too small to justify the cost increase given current UK thresholds cost‐effective policy was selective ultrasound coupled with induction of labour where macrosomia was suspected. Conclusions The most cost‐effective policy for detection and management of fetal macrosomia is selective ultrasound scanning coupled with induction of labour for all suspected cases of macrosomia. Universal ultrasound scanning for macrosomia in late‐stage pregnancy is not cost‐effective.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Publisher: Wiley
ISSN: 1470-0328
Date of First Compliant Deposit: 3 May 2019
Date of Acceptance: 16 April 2019
Last Modified: 05 Sep 2019 10:18
URI: http://orca.cf.ac.uk/id/eprint/122151

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