@article{81c88b7256e941c696b3595f62a1a62c,
title = "Improving antenatal detection of small-for-gestational-age fetus: economic evaluation of Growth Assessment Protocol",
abstract = "Objective: To determine whether the Growth Assessment Protocol (GAP), as implemented in the DESiGN trial, is cost-effective in terms of antenatal detection of small-for-gestational-age (SGA) neonate, when compared with standard care. Methods: This was an incremental cost-effectiveness analysis undertaken from the perspective of a UK National Health Service hospital provider. Thirteen maternity units from England, UK, were recruited to the DESiGN (DEtection of Small for GestatioNal age fetus) trial, a cluster randomized controlled trial. Singleton, non-anomalous pregnancies which delivered after 24 + 0 gestational weeks between November 2015 and February 2019 were analyzed. Probabilistic decision modeling using clinical trial data was undertaken. The main outcomes of the study were the expected incremental cost, the additional number of SGA neonates identified antenatally and the incremental cost-effectiveness ratio (ICER) (cost per additional SGA neonate identified) of implementing GAP. Secondary analysis focused on the ICER per infant quality-adjusted life year (QALY) gained. Results: The expected incremental cost (including hospital care and implementation costs) of GAP over standard care was £34 559 per 1000 births, with a 68% probability that implementation of GAP would be associated with increased costs to sustain program delivery. GAP identified an additional 1.77 SGA neonates per 1000 births (55% probability of it being more clinically effective). The ICER for GAP was £19 525 per additional SGA neonate identified, with a 44% probability that GAP would both increase cost and identify more SGA neonates compared with standard care. The probability of GAP being the dominant clinical strategy was low (11%). The expected incremental cost per infant QALY gained ranged from £68 242 to £545 940, depending on assumptions regarding the QALY value of detection of SGA. Conclusion: The economic case for replacing standard care with GAP is weak based on the analysis reported in our study. However, this conclusion should be viewed taking into account that cost-effectiveness analyses are always limited by the assumptions made.",
keywords = "antenatal screening, cost-effectiveness, economic evaluation, growth assessment protocol, SGA",
author = "{on behalf of the DESIGN Trial team} and S. Relph and Vieira, {M. C.} and A. Copas and K. Coxon and A. Alagna and A. Briley and M. Johnson and L. Page and D. Peebles and A. Shennan and B. Thilaganathan and N. Marlow and C. Lees and Lawlor, {D. A.} and A. Khalil and J. Sandall and D. Pasupathy and A. Healey",
note = "Funding Information: The DESiGN trial team also comprises Bolaji Coker, Maria Elstad, Walter Muruet-Gutierrez, Natalie Moitt and Louisa Delaney (all of King's College London) and Professor Lesley McCowan of the University of Auckland. We would like to thank the members of the DESiGN Collaborative Group for their contribution to this trial: Spyros Bakalis, Claire Rozette and Marcelo Canda (Guy's and St Thomas' Hospital NHS Foundation Trust), Simona Cicero, Olayinka Akinfenwa, Philippa Cox and Lisa Giacometti (Homerton University Hospital NHS Foundation Trust), Elisabeth Peregrine, Lyndsey Smith and Sam Page (Kingston Hospital NHS Foundation Trust), Deepa Janga and Sandra Essien (North Middlesex University Hospital NHS Trust), Renata Hutt (Royal Surrey County Hospital NHS Foundation Trust), Yaa Acheampong, Bonnie Trinder and Louise Rimell (St George's University Hospitals NHS Foundation Trust), Janet Cresswell and Sarah Petty (Chesterfield Royal Hospital NHS Foundation Trust), Bini Ajay, Hannah O'Donnell and Emma Wayman (Croydon Health Services NHS Trust), Mandish Dhanjal, Muna Noori and Elisa Iaschi (Imperial College Healthcare NHS Trust), Raffaele Napolitano, Iris Tsikimi and Rachel Das (University College London Hospitals NHS Foundation Trust), Fiona Ghalustians and Francesca Hanks (Chelsea and Westminster Hospital NHS Foundation Trust), Laura Camarasa (Hillingdon Hospitals NHS Foundation Trust) and Hiran Samarage and Stephen Hiles (London North West Healthcare NHS Trust). We would also like to thank the DESiGN Trial Steering Committee/Data Monitoring Committee members: Anna David (University College London), David Howe (University Hospital Southampton), Nadine Seward (King's College London), Elizabeth Allen (London School of Hygiene and Tropical Medicine) and Jillian Francis (University of Melbourne). Finally, we wish to thank the Stillbirth Clinical Study Group and the Royal College of Obstetricians and Gynaecologists for reviewing the study protocol during development of the study. This study was funded by Guy's and St Thomas' Charity (MAJ150704), Stillbirth and Neonatal Death Charity - SANDS (RG1011/16) and Tommy's Charity. M.C.V. was supported by CAPES (BEX 9571/13–2). S.R., K.C. and A.H. were supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust. A.H. is also a member of King's Improvement Science, which offers cofunding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas' Charity and the Maudsley Charity. N.M. receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme at UCLH/UCL. D.A.L.'s contributions were supported by the Bristol NIHR Biomedical Research Centre and her NIHR Senior Investigator Award (NF-0616-10102). J.S. is supported by an NIHR Senior Investigator Award and the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. D.P. was funded by Tommy's Charity during the period of the study. The views expressed are those of the author[s] and not necessarily those of the NIHR, the Department of Health and Social Care or any of the other listed funders. None of the funders influenced the design, analyses or interpretation of results. N.M. reports receiving personal fees from Takeda, personal fees from RSM Consulting and personal fees from Novartis, outside the submitted work. B.T. is the Clinical Director of the Tommy's National Centre for Maternity Improvement based at the Royal College of Obstetricians and Gynaecologists; the Centre's objective is to translate the latest evidence into clinical practice in the UK. D.A.L. has received support from Medtronic Ltd and Roche Diagnostics for research unrelated to that presented here. Funding Information: This study was funded by Guy's and St Thomas' Charity (MAJ150704), Stillbirth and Neonatal Death Charity ‐ SANDS (RG1011/16) and Tommy's Charity. M.C.V. was supported by CAPES (BEX 9571/13–2). S.R., K.C. and A.H. were supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust. A.H. is also a member of King's Improvement Science, which offers cofunding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas' Charity and the Maudsley Charity. N.M. receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme at UCLH/UCL. D.A.L.'s contributions were supported by the Bristol NIHR Biomedical Research Centre and her NIHR Senior Investigator Award (NF‐0616‐10102). J.S. is supported by an NIHR Senior Investigator Award and the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. D.P. was funded by Tommy's Charity during the period of the study. The views expressed are those of the author[s] and not necessarily those of the NIHR, the Department of Health and Social Care or any of the other listed funders. None of the funders influenced the design, analyses or interpretation of results. Publisher Copyright: {\textcopyright} 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.",
year = "2022",
month = nov,
doi = "10.1002/uog.26022",
language = "English",
volume = "60",
pages = "620--631",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley and Sons Ltd",
number = "5",
}