Placental alpha-microglobulin-1 and combined traditional diagnostic test: a cost-benefit analysis.

Autor: Echebiri NC; Department of Obstetrics and Gynecology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY. Electronic address: nelsonechebiri@gmail.com., McDoom MM; Social Science Research Center, Mississippi State University, Starkville, MS; Department of Global Health and Population, Harvard School of Public Health, Boston, MA., Pullen JA; Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK., Aalto MM; Department of Obstetrics and Gynecology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY., Patel NN; Department of Obstetrics and Gynecology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY., Doyle NM; Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK.
Jazyk: angličtina
Zdroj: American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2015 Jan; Vol. 212 (1), pp. 77.e1-10. Date of Electronic Publication: 2014 Jul 22.
DOI: 10.1016/j.ajog.2014.07.028
Abstrakt: Objective: We sought to evaluate if the placental alpha-microglobulin (PAMG)-1 test vs the combined traditional diagnostic test (CTDT) of pooling, nitrazine, and ferning would be a cost-beneficial screening strategy in the setting of potential preterm premature rupture of membranes.
Study Design: A decision analysis model was used to estimate the economic impact of PAMG-1 test vs the CTDT on preterm delivery costs from a societal perspective. Our primary outcome was the annual net cost-benefit per person tested. Baseline probabilities and costs assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2013 US dollars.
Results: Annual net benefit from PAMG-1 was $20,014 per person tested, while CTDT had a net benefit of $15,757 per person tested. If the probability of rupture is <38%, PAMG-1 will be cost-beneficial with an annual net benefit of $16,000-37,000 per person tested, while CTDT will have an annual net benefit of $16,000-19,500 per person tested. If the probability of rupture is >38%, CTDT is more cost-beneficial. Monte Carlo simulations of 1 million trials selected PAMG-1 as the optimal strategy with a frequency of 89%, while CTDT was only selected as the optimal strategy with a frequency of 11%. Sensitivity analyses were robust.
Conclusion: Our cost-benefit analysis provides the economic evidence for the adoption of PAMG-1 in diagnosing preterm premature rupture of membranes in uncertain presentations and when CTDT is equivocal at 34 to <37 weeks' gestation.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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