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#Grand Rounds

Universal Ultrasound Screening for Fetal Macrosomia: Is It Cost-Effective?

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BACKGROUND AND PURPOSE:

  • Wastlund et al. (BJOG, 2019) sought to determine the most cost-effective strategy for fetal macrosomia detection in the third trimester

METHODS:

  • Health economic simulation model
  • Participants
    • Nulliparous | Third Trimester | Based on treatment within the UK NHS system
  • Study design
    • Two detection strategies for fetal macrosomia detection
      • Universal ultrasound scanning at approximately 36 weeks
      • Selective ultrasound scanning
    • Three management strategies
      • Planned caesarean section
      • Induction of labor
      • Expectant management
    • Probabilities, costs and health outcomes based on the literature
    • Potential litigation costs not included
  • Primary outcomes
    • Expected costs to the NHS and quality-adjusted life-years (QALYs) gained from each strategy
    • Calculation of net benefit and most cost-effective strategy

RESULTS:

  • Compared with selective ultrasound, universal ultrasound (planned cesarean)
    • Increased QALYs (over 20 years) by 0.0038 (95% CI, 0.0012 to 0.0076)
    • Increased costs by £123.50 (95% CI, 99.6 to 149.9)
  • The most cost-effective policy was selective ultrasound coupled with induction of labor where macrosomia was suspected

CONCLUSION:

  • The most cost-effective strategy for detecting and managing suspected fetal macrosomia is selective ultrasound and induction of labor
  • The health gain to universal screening is so small is because risk of severe neonatal outcomes resulting from undiagnosed macrosomia is low vs the risk of interventions
  • If the cost of the ultrasound dropped substantially in price, universal scanning could become cost-effective (a reduction of approximately 75%)
    • Combining the scan to assess breech presentation could also potentially tip the balance regarding cost-effectiveness

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Learn More – Primary Sources:

The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis

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Related ObG Topics:

Does Suspected Macrosomia Impact Labor Management?
Is Universal Prenatal HCV Screening Cost-Effective?
Can Universal Ultrasound Screening for Breech Presentation Reduce Fetal Mortality and be Cost-Effective?

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