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- W3127670708 abstract "To determine whether selective fetoscopic laser photocoagulation (SFLP) or expectant management (EM) is a cost-effective strategy for management of Quintero stage I twin-twin transfusion syndrome (TTTS). A decision-analysis (DA) model compared SFLP to EM for 100000 pregnant people with monochorionic-diamniotic twins affected by stage I TTTS. All subjects were assumed to be appropriate candidates for either strategy. Probabilities, costs, and utilities were derived from the literature. The DA was conducted from a health care payor perspective and the analytic horizon was over the course of a child’s lifetime, with primary outcomes of survivorship (i.e., no intrauterine fetal demise or neonatal death) and long-term neurodevelopmental impairment (NDI). Markov processes were employed, cycling every 4 weeks throughout pregnancy. Incremental cost-effectiveness ratios (ICER) for each strategy were calculated and compared to determine marginal cost effectiveness. An ICER of $100,000 per quality-adjusted life year (QALY) was used to define the cost-effectiveness threshold. One-way sensitivity and Monte Carlo analyses (MCA) were performed. For base-case estimates, SFLP was found to be cost effective compared to EM in the management of stage I TTTS (Table). Compared to EM, SFLP resulted in 29184 fewer pregnancies affected with no survivors; 2346 more pregnancies with 1 survivor, and 26838 more pregnancies with 2 survivors. Furthermore, there were 4649 fewer cases of NDI. On one-way sensitivity analyses, if the probability of NDI after SFLP for pregnancies affected by stage I TTTS was above 0.078, then EM was the cost-effective strategy (Figure). MCA demonstrated that SFLP was cost-effective in 98.1% of runs. With base-case estimates, SFLP is a more cost-effective strategy than EM for the treatment of Stage I TTTS. However, given the limited data informing base-case estimates, further determination of outcome probabilities is needed to determine with high confidence which strategy is more cost-effective.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W3127670708 date "2021-02-01" @default.
- W3127670708 modified "2023-09-25" @default.
- W3127670708 title "323 Selective fetoscopic laser or expectant management for quintero stage i twin-twin transfusion: a cost-effectiveness analysis" @default.
- W3127670708 doi "https://doi.org/10.1016/j.ajog.2020.12.344" @default.
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