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ILLUSTRATIVE ESTIMATES OF COSTS AND EFFECTS OF THE USE OF DOPPLER ULTRASONOGRAPHY IN HIGH-RISK PREGNANCIES

Published online by Cambridge University Press:  21 April 2004

Hanne Brix Westergaard ,
Jan Sørensen  and
Jens Langhoff-Roos
Hanne Brix Westergaard
Affiliation:
Copenhagen University Hospital
Jan Sørensen
Affiliation:
University of Southern Denmark
Jens Langhoff-Roos
Affiliation:
Copenhagen University Hospital
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Abstract

Objectives: To examine the cost-effectiveness of Doppler ultrasonography in high-risk pregnancies.

Methods: An analysis was made of the cost-effectiveness of Doppler ultrasonography in high-risk pregnancies in relation to different organizational models. National costs of Doppler ultrasonography for singleton pregnancies with intrauterine growth retardation were estimated for three models. The cost-effectiveness analysis was based on results from a meta-analysis on clinical effects, patient costs, immediate health care costs, and costs per “saved” perinatal death.

Results: In the decentralized model (the current situation in Denmark), incremental health care costs were estimated to be 13.5 million DKK, with patient costs set at zero. In the regional and centralized models, the estimated costs were 9.3 million/0.9 million DKK and 3.4 million/2.6 million DKK, respectively. The incremental costs were more than outweighed by the savings made from significant reductions in obstetric interventions. The centralized model dominated the other two models in the cost-effective analysis. In the decentralized model, the costs of avoiding one perinatal death were estimated to be 1 million DKK. The sensitivity analysis suggested that the cost-effectiveness ratio differed considerably, depending on the assumptions used, although the rank order of the three models did not change.

Conclusions: The cost-effectiveness analysis showed that a centralized model with five obstetric centers offering Doppler ultrasonography dominates the regional and decentralized models. However, even with the decentralized model (which reflects the current situation in Denmark), the costs of avoiding one perinatal death would seem to be reasonable. In view of the paucity of available cost and effects data and the sensitivity of the results to changes in the assumptions made, more reliable information is needed before a decision can be made regarding the organization of Doppler ultrasonography for high-risk pregnancies.

Keywords

Doppler ultrasonographyPregnancyCost analysisOrganizations
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 19 , Issue 4 , December 2003 , pp. 624 - 631
Copyright
© 2004 Cambridge University Press

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References

1994 Report of the subgroup for the rational use of ultrasound. J Perinat Med. 22: 455- 462.
Almström H, Axelsson O, Cnattinguis S et al. 1992 Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet. 340: 936- 940.Google Scholar
Bricker L, Garcia J, Henderson J et al. 2000 Ultrasound screening in pregnancy: A systematic review of the clinical effectiveness, cost-effectiveness and women's views. Health Technol Assess. 4: i- iv.Google Scholar
Dirksen A, Mosbech J, Bay-Nielsen H, Frimodt-Møller B, Reinländer B. 1992 International classification of diseases. 2nd ed. Copenhagen: Munksgaard
Haley J, Tuffnell DJ, Johnson N. 1997 Randomised controlled trial of cardiotocography versus umbilical artery Doppler in the management of small for gestational age fetuses. Br J Obstet Gynaecol. 104: 431- 435.Google Scholar
Laurin J, Lingman G, Marsal K, Persson P-H. 1987 Fetal blood flow in pregnancies complicated by intrauterine growth retardation. Obstet Gynecol. 69: 895- 902.Google Scholar
Neilson JP, Alfirevic Z. 2001 Doppler ultrasound for fetal assessment in high risk pregnancies (Cochrane Review). In: The Cochrane Library. Oxford: Update Software. Issue 2.
Nienhuis SJ. 1995 Costs and effect of Doppler ultrasound measurements in suspected intrauterine growth retardation. Thesis. University of Maastricht
Roberts T, Mugford M, Piercy J. 1998 Choosing options for ultrasound screening in pregnancy and comparing cost effectiveness: A decision analysis approach. Br J Obstet Gynaecol. 105: 960- 970.Google Scholar
Westergaard HB. 2001 [Doppler ultrasound in high risk pregnancies - A Health Technology Assessment]. Westergaard HB, Langhoff-Roos J, eds. Copenhagen, Danish Institute of Health Technology Assessment. Available at: http://www.cemtv.dk/projekter/56_uk.asp.
Westergaard HB. 2002 Umbilical artery Doppler ultrasonography in high risk pregnancies: A health technology assessment. Thesis. University of Copenhagen
Westergaard HB, Langhoff-Roos J. 2001 Doppler ultrasonography in singleton pregnancies at risk of intrauterine growth retardation: A national estimate. Acta Obstet Gynecol Scand. 81: 534- 539.Google Scholar
Westergaard HB, Langhoff-Roos J, Lingman G, Marsal K. 2000 A critical appraisal of the use of umbilical artery Doppler ultrasound in high risk pregnancies: Use of meta-analyses in evidence-based obstetrics. Ultrasound Obstet Gynecol. 17: 466- 476.Google Scholar