The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial.

OBJECTIVES: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. DESIGN: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. SETTING: Forty-eight UK NHS early pregnancy units. POPULATION: Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. METHODS: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. MAIN OUTCOME MEASURES: Cost per additional live birth at ≥34 weeks of gestation. RESULTS: Progesterone intervention led to an effect difference of 0.022 (95% CI -0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI -£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014-0.096) and this was associated with a cost saving of £322 (95% CI -£1318 to £673). CONCLUSIONS: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). TWEETABLE ABSTRACT: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.

Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study.

OBJECTIVE: To investigate the impact of maternal body mass index (BMI, kg/m(2)) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland. DESIGN: Retrospective cohort study using an unselected population database. SETTING: Obstetric units in Scotland, 2003-2010. POPULATION: A total of 124,280 singleton deliveries in 109,592 women with a maternal BMI recorded prior to 16 weeks of gestation. METHODS: Population-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs. MAIN OUTCOME MEASURES: Maternal and offspring outcomes, number and duration of hospital admissions, and healthcare costs. RESULTS: Using multivariable analysis, in comparison with women of normal weight, women who were overweight, obese, or severely obese had an increased risk of essential hypertension [1.87 (1.18-2.96), 11.90 (7.18-19.72), and 36.10 (18.33-71.10)], pregnancy-induced hypertension [1.76 (1.60-1.95), 2.98 (2.65-3.36), and 4.48 (3.57-5.63)], gestational diabetes [3.39 (2.30-4.99), 11.90 (7.54-18.79), and 67.40 (37.84-120.03)], emergency caesarean section [1.94 (1.71-2.21), 3.40 (2.91-3.96), and 14.34 (9.38-21.94)], and elective caesarean section [2.06 (1.84-2.30), 4.61 (4.06-5.24), and 17.92 (13.20-24.34)]. Compared with women of normal weight, women who were underweight, overweight, obese, or severely obese were associated with an 8, 16, 45, and 88% increase in the number of admissions, respectively, and women who were overweight, obese, or severely obese were associated with a 4, 9, and 12% increase in the duration of stay (all P < 0.001). The additional maternity costs [mean (95% CI), adjusted analyses] for women who were underweight, overweight, obese, or severely obese were £102.27 (£48.49-156.06), £59.89 (£41.61-78.17), £202.46 (£178.61-226.31), and £350.75 (£284.82-416.69), respectively. CONCLUSIONS: Maternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.

The efficacy of fetal fibronectin testing in minimising hospital admissions, length of hospital stay and cost savings in women presenting with symptoms of pre-term labour.

The following review includes a number of studies on the effect of fetal fibronectin (fFN) testing and non-testing, as well as the positive and negative test results, some combining with transvaginal ultrasonographic measurement of cervical length primarily to reduce hospital admissions and length of hospital stay (with associated reduction in health service costs), in women presenting to hospital with symptoms of pre-term labour. English language medical literature was analysed using the search parameters: fetal fibronectin, cervical length, preterm labour, hospital admissions and length of stay. A total of 19 studies were included. Ten of these discussed the role of fFN in decreasing hospital admissions, transfers, length of stay and interventions like corticosteroids and tocolytics. Seven studies demonstrated a correlation of fFN testing with an actual estimate of cost savings of health resources. Five studies explored the combined predictability of fetal fibronectin and cervical length with regards to pre-term labour.

The cost-effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate prior to induction of labour.

OBJECTIVES: To assess the cost-effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate (IMN) prior to induction of labour. DESIGN: Economic evaluation was conducted alongside a randomised placebo controlled trial (the IMOP trial). SETTING: Large UK maternity hospital. POPULATION: A total of 350 nulliparous women with a singleton pregnancy, cephalic presentation > or = 37 weeks gestation, requiring cervical ripening prior to induction of labour. INTERVENTIONS: Isosorbide mononitrate (n = 177) or placebo (n = 173) self-administered vaginally at home at 48, 32 and 16 hours prior to the scheduled time of admission for induction. RESULTS: Mean health service costs between the period of randomisation and discharge for mother and infant were 1254.86 pound sterling in the IMN group and 1242.88 pound sterling in the placebo group, generating a mean cost difference of 11.98 pound sterling (bootstrap mean cost difference 12.86 pound sterling; 95%CI: -106.79 pound sterling, 129.39 pound sterling) that was not statistically significant (P = 0.842). The incremental cost per hour prevented from hospital admission to delivery was 7.53 pound sterling. At the notional willingness to pay threshold of 100 pound sterling per hour prevented from hospital admission to delivery, the probability that IMN is cost-effective was estimated at 0.67. This translated into a mean net monetary benefit of 98.13 pound sterling for each woman given IMN. CONCLUSIONS: Although the probability that IMN is cost-effective approaches 0.7 at seemingly low willingness to pay thresholds for an hour prevented from hospital admission to delivery, our results should be viewed in the light of the clinical findings from the IMOP trial.

Factors influencing women's views on the acceptability and experience of being opportunistically screened for Chlamydia trachomatis in hospital settings.

A subsample of 681 women participating in a two-centred, three-setting larger (2817) prevalence study were approached and, with consent, administered a questionnaire by post or in person. The questionnaire asked about their views of opportunistic screening for Chlamydia trachomatis (CT). The study response rate was 71%. In all, 94% women reported screening should be offered and most, on a regular basis. About 91% thought men should be screened but only 47% thought they would attend. Most (89%) knew the term 'chlamydia' but fewer, (63%) knew they could catch CT more than once. This is one of the very few UK studies which has explored women's views towards the acceptability of CT screening. Results suggest the majority of women report that screening for the condition is acceptable but not all have in-depth knowledge of CT. If a screening programme is to be established more education regarding the condition is required.

NHLBI workshop on the utilization of ECG databases: preservation and use of existing ECG databases and development of future resources.

Baseline examinations and periodic reexaminations in longitudinal population studies, together with ongoing surveillance for morbidity and mortality, provide unique opportunities for seeking ways to enhance the value of the electrocardiogram (ECG) recorded with digital technology as an inexpensive and noninvasive tool for prognosis and diagnosis. Clinicians, epidemiologists, and engineers from industry, government, and academic medical centers gathered at a workshop sponsored by the National Heart, Lung, and Blood Institute (NHLBI) on June 11-12, 1997, to discuss the research potential of ECG databases, their preservation and accession, and standards for recording and storage. Databases considered were those acquired in ongoing and future NHLBI-funded studies and in clinical settings in which the ECG continues to provide valuable information for evaluation and treatment. The accessibility of existing databases, the quality of their data, and the availability of ancillary demographic and clinical information were major themes. Also discussed were appropriate statistical methodologies to be used with these data for developing and testing ECG algorithms. The workshop participants affirmed the value of these databases and urged the establishment of an ECG advisory and review group to (1) resolve technical and proprietary issues for the utilization of currently existing databases; (2) develop standards for recording, storage, and utilization of ECGs in future NHLBI-supported studies; (3) oversee the creation of a national ECG database resource, consisting of an archive of ECG databases from past and ongoing NHLBI-supported studies, and a registry of ECG databases that would eventually include digital ECGs from populations currently underrepresented in the demographic spectrum of the NHLBI databases.

Epidemiology of multiple sclerosis in U.S. veterans: 1. Race, sex, and geographic distribution.

Five thousand three hundred five World War II and Korean conflict veterans who have been compensated by the Veterans Administration for multiple sclerosis (MS) were matched to controls on the basis of age, date of entry into military service, and branch of service. Case/control ratios for white males, white females, and black males were 1.04, 1.86, and 0.45, respectively. The coterminous 48 states, divided into three tiers on the basis of latitude, exhibited the well-known north-south gradient in risk: For all races and both sexes, case/control ratios were 1.41, 1.00, and 0.53 for the North, Middle, and South tiers. Both white females and black males showed this same north-to-south variation in risk. The case/control ratio for males of races other than black or white was 0.23, with possible deficits in risk for American Indians and Japanese-Americans. Filipinos and Hawaiian Japanese were significantly low-risk groups. These findings suggest that both a racial and a possibly genetic predisposition, as well as a geographically determined differential exposure to an environmental agent, are related to the risk of MS.