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CERVICAL PESSARY COMPARED TO VAGINAL PROGESTERONE IN PREVENTION OF PRETERM BIRTH AMONG SINGLETON PREGNANTS WITH SHORT CERVIX: A COST-EFFECTIVENESS ANALYSIS
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Abstract
Background: Preterm birth (PTB) is a global public health concern due to its economic burden. Cervical pessary and vaginal progesterone are recommended strategies for preventing PTB and reducing the associated morbidity and mortality in preterm infants. This study aimed to conduct a cost-effectiveness analysis comparing cervical pessary and vaginal progesterone for the prevention of PTB in singleton pregnancies with a short cervix. Methods: We conducted a retrospective cohort study of 208 pregnant women aged 18 years or older with a cervical length <25 mm and a gestational age of 16-22 weeks at My Duc hospital in 2021. Patient data was collected, aggregated, sorted, and analyzed using Excel and R statistical package. Cost-effectiveness was evaluated by calculating the incremental cost-effectiveness ratio (ICER) and willingness-to-pay (WTP) thresholds. Results: Among the selected participants, 106 received cervical pessary and the remaining received vaginal progesterone therapy. No significant differences were found in baseline characteristics, postpartum costs, screening tests, medications, or hospitalization costs between the pessary and progesterone groups. The mean maternal age, cervical length, and BMI were 31.1±4.3 years, 23.1±2.6 mm, and 21.6±3.1 kg/m2, respectively. The total direct cost of the pessary group was 143.7 million VND less than that of the progesterone group. The mean direct medical cost and probability of term birth were 33.6±6.2 million VND and 0.915 in the pessary group, and 36.3±6.6 million VND and 0.931 in the progesterone group. The ICER of progesterone compared to pessary was 170.0 million VND per incremental non-preterm delivery. Cervical pessary was considered cost-effective compared to progesterone therapy only if the WTP threshold was below 126 million VND per incremental non-preterm delivery. Conclusion: Cervical pessary was found to be a cost-effective option for the prevention of PTB in singleton pregnancies with a short cervix, as it resulted in lower direct medical costs and a comparable probability of term birth compared to vaginal progesterone therapy. However, vaginal progesterone was more effective in preventing preterm delivery, albeit at a higher cost. These findings can aid in making informed decisions regarding the use of these interventions in this patient population.
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Keywords
cost-effectiveness, preterm birth, cervical pessary, vaginal progesterone.
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