OBJECTIVES: Preterm birth (PTB) carries increased risk of health problems for infants as well as higher healthcare costs for both infants and mothers. We evaluated the cost-effectiveness of a risk-screening-and-treat strategy, compared to usual care, for a population of commercially-insured pregnant US women without known risk factors for PTB. The strategy included a novel PTB prognostic test (PreTRM^®) in the 19^th-20^th week of pregnancy and treatment with vaginal progesterone and high-intensity case management for the remainder of the pregnancy for women assessed as high-risk.

METHODS: A decision-tree with Markov nodes representing 1-week cycles from week 19 of pregnancy to birth (preterm or full-term) was developed, using a payer’s perspective and time horizon from pregnancy start to 12-months post-delivery in mothers and 30-months from birth in infants. PTB rates and costs were based on real-world cohorts of >40,000 mothers and infants with birth events in 2016, as identified in administrative claims from the HealthCore Integrated Research Database^®. Estimates of test performance and treatment effectiveness were derived from published literature. Uncertainty was explored via scenario, one-way, and probabilistic sensitivity analysis (PSA).

RESULTS: In the base-case analysis, the risk-screening-and-treat strategy dominated usual care with 870 fewer PTBs (20% reduction) and $54 million less in total cost ($863 net savings per pregnant woman). Reductions were also seen for neonatal-intensive-care-unit admissions (10%), overall length-of-stay (7%), and births <32 weeks gestation (33%). Treatment effectiveness had the most influence on cost-effectiveness estimates per one-way sensitivity analysis, followed by infant care costs and test costs. The risk-screening-and-treat strategy was dominant in the majority of PSA simulations and model scenarios.

CONCLUSIONS: Use of a novel prognostic test during pregnancy to identify women at risk of PTB combined with evidence-based treatment can reduce total costs and prevent preterm deliveries and their consequences in a representative population of commercially-insured US women.