Emily Griffin

Cost‐Effectiveness Analysis of Latent versus Active Labor Hospital Admission for Medically Low‐Risk, Term Women

OBJECTIVE To assess the outcomes and costs of hospital admission during the latent versus active phase of labor. Latent labor hospital admission has been consistently associated with elevated maternal risk for increased interventions, including epidural anesthesia and cesarean delivery, longer hospital stay, and higher utilization of hospital resources. METHODS A cost-effectiveness model was built to simulate a theoretic cohort of 3.2 million term, medically low-risk women either being admitted in latent labor (< 4 cm dilation) or delaying admission until active labor (≥ 4 cm dilation). Outcomes included epidural use, mode of delivery, stillbirth, maternal death, and costs of care. All probability, cost, and utility estimates were derived from the literature, and total quality-adjusted life years were calculated. Sensitivity analyses and a Monte Carlo simulation were used to investigate the robustness of model assumptions. RESULTS Delaying admission until active labor would result in 672,000 fewer epidurals, 67,232 fewer cesarean deliveries, and 9.6 fewer maternal deaths in our theoretic cohort as compared to admission during latent labor. Additionally, delaying admission results in a cost savings of

Down syndrome: perinatal mortality risks with each additional week of expectant management

694 million annually in the United States. Sensitivity analyses indicated the model was robust within a wide range of probabilities and costs. Monte Carlo simulation found that delayed admission was the optimal strategy in 76.79 percent of trials. CONCLUSION Delaying admission until active labor is a dominant strategy, resulting in both better outcomes and lower costs. Issues related to clinical translation of these findings are explored.

Role of Genetic Ultrasonogram After Choroid Plexus Cyst Detection: A Cost-Effectiveness Analysis [371]

To evaluate the gestational age (GA) at which perinatal mortality risk is minimized for fetuses with Down syndrome (DS).

129: Non-invasive prenatal testing versus standard first- and second-trimester screening for the diagnosis of aneuploidy in women of advanced maternal age

OBJECTIVE: In May 2014, the Fetal Imaging Workshop endorsed ultrasonographic follow-up in fetuses with isolated choroid plexus cysts that lacked a complete targeted scan for additional findings associated with trisomy 18 or had an elevated a priori risk. Our goal was to estimate outcomes and costs associated with this recommendation in women with prior aneuploidy screening. METHODS: A decision-analytic model was constructed using TreeAge software and probabilities derived from the literature. The model compared using a targeted ultrasonography with no follow-up in women with a negative quad screen and fetal choroid plexus cysts identified on screening ultrasonography. We stratified by maternal age younger than or older than 35 years of age. Ultrasonographic sensitivity for trisomy 18 was 97%. Outcomes of interest included diagnosis of trisomy 18, pregnancy termination, and trisomy 18 live births. Strategies were compared to generate a cost-effectiveness ratio with a threshold of

128: Non-invasive prenatal testing versus invasive testing with array for the diagnosis of chromosome disorders in women of advanced maternal age

100,000 per quality-adjusted life-year. RESULTS: The targeted ultrasonographic strategy in women younger than 35 years resulted in 20 fewer trisomy 18 births and 7.6 additional quality-adjusted life-years per 10,000 pregnancies but was not cost-effective when compared with no further screening. In women 35 years and older, the targeted ultrasonographic strategy resulted in 39 fewer trisomy 18 births and 21.3 additional quality-adjusted life-years per 10,000 pregnancies, yielding a cost-effective strategy of

Isolated Echogenic Intracardiac Foci: A Comparison of Aneuploidy Screening Tests [28P]

36,438 per quality-adjusted life-year. CONCLUSION: Our results indicate in a population with prior negative aneuploidy screening, there is increased effectiveness by offering a targeted ultrasonography when a choroid plexus cyst is visualized and it is unknown if it is isolated. However, such ultrasonograms are only cost-effective in a high-risk population.