Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-19T01:23:36.929Z Has data issue: false hasContentIssue false
  • English
  • Français

Study of progesterone for the prevention of preterm birth in twins (STOPPIT): Findings from a trial-based cost-effectiveness analysis

Published online by Cambridge University Press:  15 April 2010

Oya Eddama ,
Stavros Petrou ,
Dean Regier ,
John Norrie ,
Graeme MacLennan ,
Fiona Mackenzie  and
Jane E. Norman
Oya Eddama
Affiliation:
University of Oxford
Stavros Petrou
Affiliation:
University of Oxford
Dean Regier
Affiliation:
University of Oxford
John Norrie
Affiliation:
University of Glasgow
Graeme MacLennan
Affiliation:
University of Aberdeen
Fiona Mackenzie
Affiliation:
Princess Royal Maternity Hospital
Jane E. Norman
Affiliation:
University of Edinburgh
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Preterm birth contributes to a range of healthcare problems amongst infants surmounting to sizeable healthcare costs. Twin pregnancies are at particular risk of preterm birth. The objective of this study was to assess the cost-effectiveness of vaginal progesterone gel for the prevention of preterm birth in twin pregnancies.

Methods: An economic evaluation was conducted alongside a randomized placebo controlled trial (the STOPPIT trial) of vaginal progesterone gel for the prevention of preterm birth in twin pregnancies. Five hundred women were recruited from nine maternity hospitals in the United Kingdom. The outcomes of the economic evaluation were presented in terms of net benefit statistics, cost-effectiveness acceptability curves, generated using the nonparametric bootstrap method, and the expected value of perfect information.

Results: Mean health service costs between the period of randomization and discharge for mother and infant were £28,031 in the progesterone group and £25,972 in the placebo group, generating a mean nonsignificant cost difference of £2,059 (bootstrap mean cost difference £2,334; 95 percent confidence interval: −£5,023, £9,142; p = .33). The probability of progesterone being cost-effective was 20 percent at a willingness to pay threshold of £30,000 per preterm birth prevented. There is little economic justification for conducting further research into the use of vaginal progesterone gel in twin pregnancies for the prevention of preterm birth.

Conclusions: Further studies of preventive interventions for preterm birth more generally are required given the scale of the clinical and economic burden of this condition. These studies should be sufficiently powered for economic endpoints and extend beyond hospital discharge.

Keywords

ObstetricsEconomic evaluationCost-effectiveness analysisValue of information
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 2 , April 2010 , pp. 141 - 148
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Barber, JA, Thompson, SG. Analysis of cost data in randomized trials: An application of the non-parametric bootstrap. Stat Med. 2000;19:3219–3236.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
2. Berghella, V, Odibo, AO, To, MS, et al. Cerclage for short cervix on ultrasonography: Meta-analysis of trials using individual patient-level data. Obstet Gynecol. 2005;106:181–189.CrossRefGoogle ScholarPubMed
3. Black, WC. The cost-effectiveness plane: A graphical representation of cost-effectiveness. Med Decis Making. 1990;10:212–214.CrossRefGoogle Scholar
4. Blondel, B, Kogan, MD, Alexander, GR, et al. The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: An international study. Am J Pubic Health. 2002;92:1323–1330.CrossRefGoogle ScholarPubMed
5. Caritis, SN, Rouse, DJ, Peaceman, AM, et al. Prevention of preterm birth in triplets using 17 alpha-hydroxyprogesterone caproate: A randomized controlled trial. Obstet Gynecol. 2009;113 (pt 1):285–292.CrossRefGoogle ScholarPubMed
6. Curtis, LA, ed. Unit costs of health and social care 2007. Canterbury, United Kingdom: Personal Social Services Research Unit, University of Kent; 2007.Google Scholar
7. Department of Health. National schedule for reference costs. London: DoH; 2008.Google Scholar
8. Dodd, JM, Flenady, VJ, Cincotta, R, Crowther, CA. Progesterone for the prevention of preterm birth: A systematic review. Obstet Gynecol. 2007;112:127–134.Google Scholar
9. Drummond, MF, O'Brien, B, Stoddart, GL, Torrance, G. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 1997.Google Scholar
10. Fenwick, E, Claxton, K, Sculpher, M. Representing uncertainty: The role of cost-effectiveness acceptability curves. Health Econ. 2001;10:779–787.CrossRefGoogle ScholarPubMed
11. Hintz, SR, Kendrick, DE, Vohr, BR, et al. National Institute of Child Health and Human Development Neonatal Research Network. Changes in neurodevelopmental outcomes at 18 to 22 months’ corrected age among infants of less than 25 weeks’ gestational age born in 1993–1999. Pediatrics. 2005;115:1645–1651.Google Scholar
12. Lim, AC, Bloemenkamp, KWM, Boer, K, et al. Study protocol: Progesterone for the prevention of preterm birth in women with multiple pregnancies: The AMPHIA trial. BMC Pregnancy Childbirth. 2007;7:7.CrossRefGoogle Scholar
13. Mugford, M, Hutton, G, Fox-Rushby, J. Methods for economic evaluation alongside a multicentre trial in developing countries: A case study form the WHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol. 1998;12:75–97.CrossRefGoogle Scholar
14. National Institute for Clinical Excellence (NICE). Guide to the methods of technology appraisal. NICE: London; 2004.Google Scholar
15. Norman, JN, Mackenzie, F, Owen, P, et al. A randomised, double blind placebo controlled STudy of Progesterone for the Prevention of Preterm Birth In Twins (STOPPIT), and a meta-analysis of the use of progesterone for prevention of preterm birth in twin pregnancy. Lancet. 2009;373:2034–2040.Google Scholar
16. Office for National Statistics. Birth statistics. http://www.statistics.gov.uk (accessed December 2009).Google Scholar
17. Papiernik, E, Keith, L, Oleszczuk, JJ, Cervantes, A. What interventions are useful in reducing the rate of preterm delivery in twins? Clin Obstet Gynecol. 1998;41:13–23.CrossRefGoogle ScholarPubMed
18. Petrou, S, Mehta, Z, Hockley, C, et al. The impact of preterm birth on hospital inpatient admissions and costs during the first five years of life. Pediatrics. 2003;112:1290–1297.Google Scholar
19. Petrou, S. Economic consequences of preterm birth and low birthweight. BJOG. 2003;110 (Suppl 20):17–23.CrossRefGoogle ScholarPubMed
20. Raikou, M, Briggs, A, Gray, A, McGuire, A. Centre-specific or average unit costs in multi-centre studies? Some theory and simulation. Health Econ. 2000;9:191–198.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
21. Repka, MX. Ophthalmological problems of the premature infant. Ment Retard Dev Disabil Res Rev. 2000;8:249–257.CrossRefGoogle Scholar
22. Rouse, DJ, Caritis, SN, Peaceman, AM, et al. A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Eng J Med. 2007;357:454–461Google Scholar
23. Stinnett, AA, Mullahy, J. Net health benefits: A new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998;18:S68–S80.Google Scholar
24. van Baar, AL, van Wassenaer, AG, Briet, JM, et al. Very preterm birth is associated with disabilities in multiple developmental domains. J Pediatr Psychol. 2005;30:247–255CrossRefGoogle ScholarPubMed