Placental alpha-microglobulin-1 and combined traditional diagnostic test: a cost-benefit analysis
| Autor: | Natasha N. Patel, Nelson C. Echebiri, Nora M. Doyle, M. Maya McDoom, Meaghan M. Aalto, Jessica Pullen |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Fetal Membranes
Premature Rupture Cost estimate Cost-Benefit Analysis Placenta Nitrazine Pooling chemistry.chemical_compound Pregnancy Alpha-Globulins Statistics Humans Medicine Diagnostic Techniques Obstetrical and Gynecological health care economics and organizations Cost–benefit analysis business.industry Decision Trees Probabilistic logic Obstetrics and Gynecology Diagnostic test medicine.disease chemistry Female business Premature rupture of membranes Decision analysis |
| Zdroj: | American Journal of Obstetrics and Gynecology. 212:77.e1-77.e10 |
| ISSN: | 0002-9378 |
| DOI: | 10.1016/j.ajog.2014.07.028 |
| Popis: | 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.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.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 is38%, 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 is38%, 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.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 to37 weeks' gestation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect