Cost-Effectiveness of a Proteomic Test for Preterm Birth Prediction

Michael Grabner; Julja Burchard; Chi Nguyen; Haechung Chung; Nilesh Gangan; J Jay Boniface; John A F Zupancic; Eric Stanek

doi:10.2147/CEOR.S325094

Cost-Effectiveness of a Proteomic Test for Preterm Birth Prediction

Clinicoecon Outcomes Res. 2021 Sep 14:13:809-820. doi: 10.2147/CEOR.S325094. eCollection 2021.

Authors

Michael Grabner¹, Julja Burchard², Chi Nguyen³, Haechung Chung⁴, Nilesh Gangan³, J Jay Boniface², John A F Zupancic⁵, Eric Stanek¹

Affiliations

¹ Scientific Affairs, HealthCore, Inc., Wilmington, DE, USA.
² Research and Development, Sera Prognostics, Salt Lake City, UT, USA.
³ Health Economics and Outcomes Research, HealthCore, Inc., Wilmington, DE, USA.
⁴ Research Operations, HealthCore, Inc., Wilmington, DE, USA.
⁵ Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Abstract

Background: Preterm birth (PTB) carries increased risk of short- and long-term health problems as well as higher healthcare costs. Current strategies using clinically accepted maternal risk factors (prior PTB, short cervix) can only identify a minority of singleton PTBs.

Objective: We modeled the cost-effectiveness of a risk-screening-and-treat strategy versus usual care for commercially insured pregnant US women without clinically accepted PTB risk factors. The risk-screening-and-treat strategy included use of a novel PTB prognostic blood test (PreTRM^®) in the 19th-20th week of pregnancy, followed by treatment with a combined regimen of multi-component high-intensity-case-management and pharmacologic interventions for the remainder of the pregnancy for women assessed as higher-risk by the test, and usual care in women without higher risk.

Methods: We built a cost-effectiveness model using a combined decision-tree/Markov approach and a US payer perspective. We modeled 1-week cycles of pregnancy from week 19 to birth (preterm or term) and assessed costs throughout the pregnancy, and further to 12-months post-delivery in mothers and 30-months in infants. PTB rates and costs were based on >40,000 mothers and infants from the HealthCore Integrated Research Database^® with birth events in 2016. Estimates of test performance, treatment effectiveness, and other model inputs were derived from published literature.

Results: In the base case, the risk-screening-and-treat strategy dominated usual care with an estimated 870 fewer PTBs (20% reduction) and $54 million less in total cost ($863 net savings per pregnant woman). Reductions were projected for neonatal intensive care admissions (10%), overall length-of-stay (7%), and births <32 weeks (33%). Treatment effectiveness had the strongest influence on cost-effectiveness estimates. The risk-screening-and-treat strategy remained dominant in the majority of probabilistic sensitivity analysis simulations and model scenarios.

Conclusion: Use of a novel prognostic test during pregnancy to identify women at risk of PTB combined with evidence-based treatment is estimated to reduce total costs while preventing PTBs and their consequences.

Keywords: cost effectiveness; preterm birth; progesterone; prognostic test.

Grants and funding

Study funding was provided by Sera Prognostics Inc., the maker of the PreTRM^® test, to HealthCore Inc.