(810) Cost-effectiveness of history indicated cerclage compared to cervical length screening in patients with cervical insufficiency.

Cost-effective management of patients with a history of cervical insufficiency is not well known. We sought to evaluate the cost-effectiveness of history-indicated cerclage compared with cervical length screening in patients with a history of cervical insufficiency.

Study Design:

We developed a decision analysis model to compare history-indicated cerclage with cervical length screening from the perspective of health care providers. The primary outcome was the incremental cost-effectiveness ratio of both strategies, defined as the estimated patient cost per quality-adjusted life year (QALY) realized by the children. Time horizon was set to be lifetime. Costs (in 2021 USD) included those for the cerclage, serial transvaginal ultrasounds, maternal care for admission, and neonatal care. Probabilities, utilities, and costs were derived from the literature and our database of patients with cervical insufficiency (Table 1). A discount rate was set at 3% yearly for both cost and effectiveness. A cost-effectiveness threshold was set at $100,000 per QALY. One-way sensitivity analysis was performed by the probability of urgent cerclage after cervical length screening (ultrasound- or physical exam indicated-cerclage).

Results:

In the base-case analysis, assuming that 42% of patients undergoing cervical length screening would have urgent cerclage, the incremental cost-effectiveness ratio for history-indicated cerclage was $-11,477/QALY. History-indicated cerclage would cost $30,625 compared with $34,828 for cervical length screening, resulting in a saving of $4203 per patient with cervical length insufficiency. In the sensitivity analysis, we found that as long as the probability of urgent cerclage after cervical length remained above 21%, history-indicated cerclage was cost-effective.

Conclusion:

In patients with a history of cervical insufficiency, history-indicated cerclage compared to cervical length screening was more cost-effective as long as the probability of urgent cerclage after cervical length remained above 21%.