Late pregnancy ultrasound to screen for and manage potential birth complications in nulliparous women: a cost-effectiveness and value of information analysis

Edward C. F. Wilson, David Wastlund, Alexandros A. Moraitis, Gordon C. S. Smith

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Fetal growth restriction is a major risk factor for stillbirth. A routine late-pregnancy ultrasound scan could help detect this, allowing intervention to reduce the risk of stillbirth. Such a scan could also detect fetal presentation and predict macrosomia. A trial powered to detect stillbirth differences would be extremely large and expensive. 

Objectives: It is therefore critical to know whether this would be a good investment of public research funds. The aim of this study is to estimate the cost-effectiveness of various late-pregnancy screening and management strategies based on current information and predict the return on investment from further research. 

Methods: Synthesis of current evidence structured into a decision model reporting expected costs, quality-adjusted life-years, and net benefit over 20 years and value-of-information analysis reporting predicted return on investment from future clinical trials. 

Results: Given a willingness to pay of £20 000 per quality-adjusted life-year gained, the most cost-effective strategy is a routine presentation-only scan for all women. Universal ultrasound screening for fetal size is unlikely to be cost-effective. Research exploring the cost implications of induction of labor has the greatest predicted return on investment. A randomized, controlled trial with an endpoint of stillbirth is extremely unlikely to be a value for money investment. 

Conclusion: Given current value-for-money thresholds in the United Kingdom, the most cost-effective strategy is to offer all pregnant women a presentation-only scan in late pregnancy. A randomized, controlled trial of screening and intervention to reduce the risk of stillbirth following universal ultrasound to detect macrosomia or fetal growth restriction is unlikely to represent a value for money investment.

Original languageEnglish
Pages (from-to)513-521
Number of pages9
JournalValue in Health
Volume24
Issue number4
Early online date21 Jan 2021
DOIs
Publication statusPublished - Apr 2021

Keywords

  • economic evaluation
  • pregnancy
  • third trimester
  • ultrasound
  • value of information analysis

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