Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial)

S. M.S. Liem, G. J. Van Baaren, F. M.C. Delemarre, I. M. Evers, G. Kleiverda, A. J. Van Loon, J. Langenveld, N. Schuitemaker, J. M. Sikkema, B. C. Opmeer, M. G. Van Pampus, B. W.J. Mol, D. J. Bekedam

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Objective To assess the cost-effectiveness of a cervical pessary to prevent preterm delivery in women with a multiple pregnancy. Methods The study design comprised an economic analysis of data from a randomized clinical trial evaluating cervical pessaries (ProTWIN). Women with a multiple pregnancy were included and an economic evaluation was performed from a societal perspective. Costs were estimated between the time of randomization and 6 weeks postpartum. The prespecified subgroup of women with a cervical length (CL) < 25 th centile (< 38 mm) was analyzed separately. The primary endpoint was poor perinatal outcome occurring up to 6 weeks postpartum. Direct medical costs and health outcomes were estimated and incremental cost-effectiveness ratios for costs to prevent one poor outcome were calculated. Results Mean costs in the pessary group (n = 401) were €21 783 vs €21 877 in the group in which no pessary was used (n = 407) (difference, -€94; 95% CI, -€5975 to €5609). In the prespecified subgroup of women with a CL < 38 mm we demonstrated a significant reduction in poor perinatal outcome (12% vs 29%; RR, 0.40; 95% CI, 0.19-0.83). Mean costs in the pessary group (n = 78) were €25 141 vs €30 577 in the no-pessary group (n = 55) (difference, -€5436 (95% CI, -€11 001 to €1456). In women with a CL < 38 mm, pessary treatment was the dominant strategy (more effective and less costly) with a probability of 94%. Conclusion Cervical pessaries in women with a multiple pregnancy involve costs comparable to those in women without pessary treatment. However, in women with a CL < 38 mm, treatment with a cervical pessary appears to be highly cost-effective.

Original languageEnglish
Pages (from-to)338-345
Number of pages8
JournalUltrasound in Obstetrics and Gynecology
Issue number3
Publication statusPublished - 1 Jan 2014
Externally publishedYes


  • cost-effectiveness
  • pessary
  • poor perinatal outcome
  • preterm birth
  • randomized controlled trial

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