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Cost-Effectiveness of Routine Third Trimester Ultrasound Screening for Fetal Growth Restriction Compared to Care as Usual in Low-Risk Pregnancies: A Pragmatic Nationwide Stepped-Wedge Cluster-Randomized Trial in The Netherlands (the IRIS Study)

Author

Listed:
  • Jens Henrichs

    (Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG and Amsterdam Public Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands)

  • Ank de Jonge

    (Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG and Amsterdam Reproduction and Development, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands)

  • Myrte Westerneng

    (Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG and Amsterdam Public Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands)

  • Viki Verfaille

    (Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG and Amsterdam Public Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands)

  • Arie Franx

    (Department of Obstetrics and Gynecology, Erasmus Medical University Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands)

  • Henriëtte E. van der Horst

    (Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands)

  • Judith E. Bosmans

    (Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands)

  • on behalf of the IRIS Study Group

    (The IRIS Study Group is provided in Appendix A.)

Abstract

Routine third trimester ultrasonography is increasingly used to screen for fetal growth restriction. However, evidence regarding its cost-effectiveness is lacking. We aimed to evaluate the cost-effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes compared to usual care (selective ultrasonography). An economic evaluation alongside a stepped-wedge cluster-randomized trial was conducted. Via 60 midwifery practices 12,974 Dutch women aged ≥16 years with low-risk pregnancies were enrolled at 22.8 (SD = 2.4) weeks’ gestation. All practices provided usual care. At 3, 7, and 10 months a third of the practices were randomized to the intervention strategy providing routine ultrasonography at 28–30 and 34–36 weeks’ gestation and usual care. The primary clinical outcome was a dichotomous composite measure of 12 severe adverse perinatal outcomes (SAPO) up to one week postpartum. Information on perinatal care and societal costs was derived from Netherlands Perinatal Registry, hospital records and a survey. Cost-effectiveness analyses revealed no significant differences in SAPO and healthcare and societal costs between the intervention strategy ( n = 7026) and usual care ( n = 5948). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was never higher than 0.6 for all possible ceiling ratios. Adding routine third trimester ultrasonography to usual care is not cost-effective in reducing SAPO.

Suggested Citation

  • Jens Henrichs & Ank de Jonge & Myrte Westerneng & Viki Verfaille & Arie Franx & Henriëtte E. van der Horst & Judith E. Bosmans & on behalf of the IRIS Study Group, 2022. "Cost-Effectiveness of Routine Third Trimester Ultrasound Screening for Fetal Growth Restriction Compared to Care as Usual in Low-Risk Pregnancies: A Pragmatic Nationwide Stepped-Wedge Cluster-Randomiz," IJERPH, MDPI, vol. 19(6), pages 1-16, March.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:6:p:3312-:d:769036
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    References listed on IDEAS

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    1. Liv Freeman & Johanna Middeldorp & Eline van den Akker & Martijn Oudijk & Caroline Bax & Marloes van Huizen & Celine Radder & Bianca Fong & Kitty Bloemenkamp & Albert Dahan & Michel Struys & Ben Wille, 2018. "An economic analysis of patient controlled remifentanil and epidural analgesia as pain relief in labour (RAVEL trial); a randomised controlled trial," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-13, October.
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