AJP Rep 2016; 06(04): e407-e416
DOI: 10.1055/s-0036-1593866
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth

Aaron B. Caughey
1  Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
John A. F. Zupancic
2  Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
James M. Greenberg
3  Division of Perinatal Institute and Neonatology, Cincinnati Children's Hospital, Cincinnati, Ohio
,
Susan S. Garfield
4  GfK, Wayland, Massachusetts
,
Stephen F. Thung
5  Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
,
Jay D. Iams
5  Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
› Author Affiliations
Further Information

Publication History

11 April 2016

18 August 2016

Publication Date:
01 December 2016 (online)

  

Abstract

Objective The objective of this study was to evaluate the potential impact to the U.S. health care system by adopting a novel test that identifies women at risk for spontaneous preterm birth.

Methods A decision-analytic model was developed to assess clinical and cost outcomes over a 1-year period. The use of a prognostic test to predict spontaneous preterm birth in a hypothetical population of women reflective of the U.S. population (predictive arm) was compared with the current baseline rate of spontaneous preterm birth and associated infant morbidity and mortality (baseline care arm).

Results In a population of 3,528,593 births, our model predicts a 23.5% reduction in infant mortality (8,300 vs. 6,343 deaths) with use of the novel test. The rate of acute conditions at birth decreased from 11.2 to 8.1%; similarly, the rate of developmental disabilities decreased from 13.2 to 11.5%. The rate of spontaneous preterm birth decreased from 9.8 to 9.1%, a reduction of 23,430 preterm births. Direct medical costs savings was $511.7M (− 2.1%) in the first year of life.

Discussion The use of a prognostic test for reducing spontaneous preterm birth is a dominant strategy that could reduce costs and improve outcomes. More research is needed once such a test is available to determine if these results are borne out upon real-world use.

* At the time of writing, Dr. Garfield was employed by GfK. However, she has since moved to Ernst & Young and has received no financial compensation associated with the development or publication of this article.


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