Research: Plugging membranes after fetoscopy in congenital diaphragmatic hernia pregnancy: early cost-effectiveness analysis

Ultrasound Obstet Gynecol

. 2023 Jan 16.

 doi: 10.1002/uog.26163. Online ahead of print.

Plugging membranes after fetoscopy in congenital diaphragmatic hernia pregnancy: early cost-effectiveness analysis

J Janssen 1J van Drongelen 2W F Daamen 3J Grutters 1 4

Affiliations expand


Objectives: Fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) fetuses improves the neonatal survival rate. However, FETO also increases the number of preterm prelabor rupture of membranes (PPROM) and preterm deliveries (PTDs) as fetal membrane defects after fetoscopy do not spontaneously heal. To solve this issue, an advanced sealing plug is being developed that closes the membrane defect. Through early-stage health economic modeling, we estimated the potential value of this innovative plug in terms of costs and effects and determined the properties for it to become cost-effective.

Methods: We applied early-stage health economic modeling to the case of performing FETO in singleton pregnant women whose fetus is prenatally diagnosed with CDH. We simulated a cohort of women using a state-transition model over a 45-year time horizon. In our best-case scenario analysis, we compared the current care strategy to a perfect plug strategy, which reduces PPROM and PTDs by 100%, to determine the maximum quality-adjusted life years (QALYs) gained and costs saved. Using threshold analysis, we determined the minimum percentage of reduction in PPROM and PTDs for the plug to be considered cost-effective. Model parameters’ impact on outcomes was investigated in a sensitivity analysis.

Results: Our model indicated that a perfect plug strategy would yield on average an additional 1.94 QALYs at a cost decrease of €2,554 per patient per year. These values were strongly influenced by the percentage of very preterm deliveries. Threshold analysis showed that, for €500 per plug, the plug strategy needs a minimum relative reduction of 1.83% in PPROM and PTDs (i.e.

Pprom: 47.50% to 46.63%, PTDs: 71.50% to 70.19%) to be cost-effective.

Conclusions: Our model-based approach showed clear potential for the plug strategy when applied in the context of FETO for CDH fetuses, as only a minor reduction in PPROM and PTDs is needed for the plug to be cost-effective. Its value is expected to be even higher when used in conditions suffering from more very preterm deliveries. Continuation of investment in the innovation’s research and development seems to provide value for money. This article is protected by copyright. All rights reserved.

Keywords: congenital diaphragmatic hernia; cost-effectiveness analysis; fetoscopic endoluminal tracheal occlusion; health economic model; preterm delivery; preterm prelabor rupture of membranes; sealing plug.

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