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Pietersma CS, Rousian M, Moolenaar L, Steegers EAP, Mulders A. Impact of first-trimester anomaly scan on health-related quality of life and healthcare costs: a scoping review. J Psychosom Obstet Gynaecol 2024; 45:2330414. [PMID: 38511633 DOI: 10.1080/0167482x.2024.2330414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
IMPORTANCE The first-trimester anomaly scan (FTAS) has the potential to detect major congenital anomalies in an early stage of pregnancy. Due to this potential early detection, there is a trend to introduce FTAS in regular care. Data regarding the impact of FTAS on the patient's perspective are limited. OBJECTIVE To provide an overview of the literature assessing the impact of the FTAS on health-related quality of life (HRQoL) and healthcare costs. EVIDENCE ACQUISITION Literature search was performed in Embase, PubMed, Medline Ovid, Cochrane Library database, Web-of-Science, and Google Scholar were searched. All studies that reported the performance of a nuchal translucency measurement with a basic fetal assessment HRQoL or healthcare costs of FTAS were included. Studies solely describing screening of chromosomal anomalies were excluded. Three authors independently screened the studies and extracted the data. Results were combined using descriptive analysis. PROSPERO registration number: CRD42016045190. RESULTS The search yielded 3242 articles and 16 were included. Thirteen articles (7045 pregnancies) examined the relationship between FTAS and HRQoL. Anxiety scores were raised temporarily before FTAS and returned to early pregnancy baseline following the absence of anomalies. Depression scores did not change significantly as a result of FTAS. Three articles studied healthcare costs. These studies, published before 2005, found a combination of FTAS and second-trimester anomaly scan (STAS) resulted in an increased amount of detected anomalies when compared to a STAS-only regimen. However, the combination would also be more costly. CONCLUSIONS Women experience anxiety in anticipation of the FTAS result and following a reassuring FTAS result, anxiety returns to the baseline level. FTAS seems to be a reassuring experience. The included studies on costs showed the addition of FTAS is likely to increase the number of detected anomalies against an increase in healthcare costs per pregnancy.Review registration: PROSPERO CRD42016045190.
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Affiliation(s)
- Carsten S Pietersma
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
| | - Lobke Moolenaar
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
| | - Annemarie Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:840-856. [PMID: 35592929 DOI: 10.1002/uog.24888] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Cité University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - V Berghella
- Thomas Jefferson University, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, PA, USA
| | - C M Bilardo
- University Medical Centre, Fetal Medicine Unit, Department of Obstetrics & Gynecology, Groningen, The Netherlands
| | - G E Chalouhi
- Maternité Necker-Enfants Malades, Université Paris Descartes, AP-HP, Paris, France
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Munoz
- University of Chile Hospital, Fetal Medicine Unit, Obstetrics & Gynecology, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Lee
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX, USA
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Viana J, Simonsen TB, Faraas HE, Schmidt N, Dahl FA, Flo K. Capacity and patient flow planning in post-term pregnancy outpatient clinics: a computer simulation modelling study. BMC Health Serv Res 2020; 20:117. [PMID: 32059727 PMCID: PMC7023739 DOI: 10.1186/s12913-020-4943-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The demand for a large Norwegian hospital's post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital's catchment area and to clinical guidelines. Planning the clinic is further complicated due to the high did not attend rates as a result of women giving birth. The aim of this study is to determine the maximum number of women specified clinic configurations, combination of specified clinic resources, can feasibly serve within clinic opening times. METHODS A hybrid agent based discrete event simulation model of the clinic was used to evaluate alternative configurations to gain insight into clinic planning and to support decision making. Clinic configurations consisted of six factors: X0: Arrivals. X1: Arrival pattern. X2: Order of midwife and doctor consultations. X3: Number of midwives. X4: Number of doctors. X5: Number of cardiotocography (CTGs) machines. A full factorial experimental design of the six factors generated 608 configurations. RESULTS Each configuration was evaluated using the following measures: Y1: Arrivals. Y2: Time last woman checks out. Y3: Women's length of stay (LoS). Y4: Clinic overrun time. Y5: Midwife waiting time (WT). Y6: Doctor WT. Y7: CTG connection WT. Optimisation was used to maximise X0 with respect to the 32 combinations of X1-X5. Configuration 0a, the base case Y1 = 7 women and Y3 = 102.97 [0.21] mins. Changing the arrival pattern (X1) and the order of the midwife and doctor consultations (X2) configuration 0d, where X3, X4, X5 = 0a, Y1 = 8 woman and Y3 86.06 [0.10] mins. CONCLUSIONS The simulation model identified the availability of CTG machines as a bottleneck in the clinic, indicated by the WT for CTG connection effect on LoS. One additional CTG machine improved clinic performance to the same degree as an extra midwife and an extra doctor. The simulation model demonstrated significant reductions to LoS can be achieved without additional resources, by changing the clinic pathway and scheduling of appointments. A more general finding is that a simulation model can be used to identify bottlenecks, and efficient ways of restructuring an outpatient clinic.
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Affiliation(s)
- Joe Viana
- Centre for Connected Care, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Health Services Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Tone Breines Simonsen
- Health Services Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Hildegunn E. Faraas
- Department of Obstetrics and Gynaecology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Nina Schmidt
- Department of Obstetrics and Gynaecology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Fredrik A. Dahl
- Health Services Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Kari Flo
- Department of Obstetrics and Gynaecology, Akershus University Hospital, 1478 Lørenskog, Norway
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Visconti F, Quaresima P, Chiefari E, Caroleo P, Arcidiacono B, Puccio L, Mirabelli M, Foti DP, Di Carlo C, Vero R, Brunetti A. First Trimester Combined Test (FTCT) as a Predictor of Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193654. [PMID: 31569431 PMCID: PMC6801433 DOI: 10.3390/ijerph16193654] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/27/2023]
Abstract
Background—The first trimester combined test (FTCT) is an effective screening tool to estimate the risk of fetal aneuploidy. It is obtained by the combination of maternal age, ultrasound fetal nuchal translucency (NT) measurement, and the maternal serum markers free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein A (PAPP-A). However, conflicting data have been reported about the association of FTCT, β-hCG, or PAPP-A with the subsequent diagnosis of gestational diabetes mellitus (GDM). Research design and methods—2410 consecutive singleton pregnant women were retrospectively enrolled in Calabria, Southern Italy. All participants underwent examinations for FTCT at 11–13 weeks (plus 6 days) of gestation, and screening for GDM at 16–18 and/or 24–28 weeks of gestation, in accordance with current Italian guidelines and the International Association Diabetes Pregnancy Study Groups (IADPSG) glycemic cut-offs. Data were examined by univariate and logistic regression analyses. Results—1814 (75.3%) pregnant women were normal glucose tolerant, while 596 (24.7%) were diagnosed with GDM. Spearman univariate analysis demonstrated a correlation between FTCT values and subsequent GDM diagnosis (ρ = 0.048, p = 0.018). The logistic regression analysis showed that women with a FTCT <1:10000 had a major GDM risk (p = 0.016), similar to women with a PAPP-A <1 multiple of the expected normal median (MoM, p = 0.014). Conversely, women with β-hCG ≥2.0 MoM had a reduced risk of GDM (p = 0.014). Conclusions—Our findings indicate that GDM susceptibility increases with fetal aneuploidy risk, and that FTCT and its related maternal serum parameters can be used as early predictors of GDM.
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Affiliation(s)
- Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Biagio Arcidiacono
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Maria Mirabelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Daniela P Foti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Raffaella Vero
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
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Souka AP, Pilalis A, Papastefanou I, Eleftheriadis M, Papadopoulos G. Quality assessment of the detailed anomaly ultrasound scan. J Matern Fetal Neonatal Med 2017; 32:666-670. [DOI: 10.1080/14767058.2017.1388366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Athena P. Souka
- Leto Maternity Hospital, Fetal Medicine Unit, Athens, Greece
- Emvryo-Mitriki Fetal Medicine Unit, Athens, Greece
| | - Athanasios Pilalis
- Leto Maternity Hospital, Fetal Medicine Unit, Athens, Greece
- Emvryo-Mitriki Fetal Medicine Unit, Athens, Greece
| | - Ioannis Papastefanou
- Leto Maternity Hospital, Fetal Medicine Unit, Athens, Greece
- Emvryo-Mitriki Fetal Medicine Unit, Athens, Greece
| | | | - George Papadopoulos
- Department of Mathematics and Statistics, Agricultural University of Athens, Athens, Greece
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Metcalfe A, Currie G, Johnson JA, Bernier F, Lix LM, Lyon AW, Tough SC. Impact of observed versus hypothesized service utilization on the incremental cost of first trimester screening and prenatal diagnosis for trisomy 21 in a Canadian province. Prenat Diagn 2013; 33:429-35. [DOI: 10.1002/pd.4082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynaecology; University of British Columbia; Vancouver Canada
| | - Gillian Currie
- Department of Pediatrics; University of Calgary; Calgary Canada
- Department of Community Health Sciences; University of Calgary; Calgary Canada
| | - Jo-Ann Johnson
- Department of Obstetrics and Gynaecology; University of Calgary; Calgary Canada
| | - Francois Bernier
- Department of Medical Genetics; Alberta Children's Hospital; Calgary Canada
| | - Lisa M. Lix
- Department of Community Health Sciences; University of Manitoba; Winnipeg Canada
| | - Andrew W. Lyon
- Department of Pathology and Laboratory Medicine, Saskatoon Health Region and College of Medicine; University of Saskatchewan; Saskatoon Canada
| | - Suzanne C. Tough
- Department of Pediatrics; University of Calgary; Calgary Canada
- Department of Community Health Sciences; University of Calgary; Calgary Canada
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Chitty LS, Hill M, White H, Wright D, Morris S. Noninvasive prenatal testing for aneuploidy-ready for prime time? Am J Obstet Gynecol 2012; 206:269-75. [PMID: 22464064 DOI: 10.1016/j.ajog.2012.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
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Prenatal ultrasonography: implications for pediatric urology. J Pediatr Urol 2011; 7:118-25. [PMID: 21227755 DOI: 10.1016/j.jpurol.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 12/07/2010] [Indexed: 11/24/2022]
Abstract
Prenatal ultrasonography has become a critical and integral component of the obstetric care of women worldwide. As a result, a number of congenital anomalies are now routinely being detected prior to birth. Anomalies affecting the genitourinary system are among those most commonly detected, and thus pediatric urologists are increasingly being asked to provide parental counseling in such situations. However, much of the data needed to enhance these discussions and provide informed consent are absent from the literature. In this review, we hope to address the published literature describing the rapidly expanding role of ultrasound in prenatal care. More importantly, however, we hope to provide some insight into the manner in which prenatal ultrasound and subsequent urologic anomaly diagnosis has affected the practice of pediatric urology.
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Hill M, Taffinder S, Chitty LS, Morris S. Incremental cost of non-invasive prenatal diagnosis versus invasive prenatal diagnosis of fetal sex in England. Prenat Diagn 2011; 31:267-73. [DOI: 10.1002/pd.2680] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 11/16/2010] [Accepted: 11/25/2010] [Indexed: 11/10/2022]
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Ramwadhdoebe S, Buskens E, Sakkers RJ, Stahl JE. A tutorial on discrete-event simulation for health policy design and decision making: Optimizing pediatric ultrasound screening for hip dysplasia as an illustration. Health Policy 2009; 93:143-50. [DOI: 10.1016/j.healthpol.2009.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 07/09/2009] [Accepted: 07/12/2009] [Indexed: 11/28/2022]
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Gekas J, Gagné G, Bujold E, Douillard D, Forest JC, Reinharz D, Rousseau F. Comparison of different strategies in prenatal screening for Down's syndrome: cost effectiveness analysis of computer simulation. BMJ 2009; 338:b138. [PMID: 19218323 PMCID: PMC2645848 DOI: 10.1136/bmj.b138] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2008] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To assess and compare the cost effectiveness of three different strategies for prenatal screening for Down's syndrome (integrated test, sequential screening, and contingent screenings) and to determine the most useful cut-off values for risk. DESIGN Computer simulations to study integrated, sequential, and contingent screening strategies with various cut-offs leading to 19 potential screening algorithms. DATA SOURCES The computer simulation was populated with data from the Serum Urine and Ultrasound Screening Study (SURUSS), real unit costs for healthcare interventions, and a population of 110 948 pregnancies from the province of Québec for the year 2001. MAIN OUTCOME MEASURES Cost effectiveness ratios, incremental cost effectiveness ratios, and screening options' outcomes. RESULTS The contingent screening strategy dominated all other screening options: it had the best cost effectiveness ratio ($C26,833 per case of Down's syndrome) with fewer procedure related euploid miscarriages and unnecessary terminations (respectively, 6 and 16 per 100,000 pregnancies). It also outperformed serum screening at the second trimester. In terms of the incremental cost effectiveness ratio, contingent screening was still dominant: compared with screening based on maternal age alone, the savings were $C30,963 per additional birth with Down's syndrome averted. Contingent screening was the only screening strategy that offered early reassurance to the majority of women (77.81%) in first trimester and minimised costs by limiting retesting during the second trimester (21.05%). For the contingent and sequential screening strategies, the choice of cut-off value for risk in the first trimester test significantly affected the cost effectiveness ratios (respectively, from $C26,833 to $C37,260 and from $C35,215 to $C45,314 per case of Down's syndrome), the number of procedure related euploid miscarriages (from 6 to 46 and from 6 to 45 per 100,000 pregnancies), and the number of unnecessary terminations (from 16 to 26 and from 16 to 25 per 100,000 pregnancies). CONCLUSIONS Contingent screening, with a first trimester cut-off value for high risk of 1 in 9, is the preferred option for prenatal screening of women for pregnancies affected by Down's syndrome.
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Affiliation(s)
- Jean Gekas
- Centre de recherche du CHUQ, Service de Génétique Médicale, Unité de Diagnostic Prénatal, Faculté de Médecine, Université Laval, Québec city, Québec, Canada.
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Hollingworth W, Spackman DE. Emerging methods in economic modeling of imaging costs and outcomes a short report on discrete event simulation. Acad Radiol 2007; 14:406-10. [PMID: 17368208 DOI: 10.1016/j.acra.2007.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 11/06/2006] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES This short report provides a non-technical overview of one emerging modeling technique, discrete event simulation (DES). METHODS A selective review of the literature that has applied DES methods to evaluate imaging technologies. RESULTS Mathematical models to evaluate the likely costs and outcomes of health technologies have become increasingly accepted. Increasing experience has also brought a mounting awareness of the limitations of conventional modeling techniques such as decision trees and Markov processes. Patient-level simulation, including DES, may provide a more flexible approach to modeling for economic evaluation of health technologies. CONCLUSIONS The strengths of DES suggest that it may have an increasingly important role in the future modeling of annual screening programs, diagnosis, and treatment of chronic recurrent disease and modeling the utilization of imaging equipment.
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Affiliation(s)
- William Hollingworth
- Department of Radiology, University of Washington, Box 359960, 325 9th Avenue, Seattle, WA 98104-2499, USA.
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Current awareness in prenatal diagnosis. Prenat Diagn 2006; 26:94-9. [PMID: 16475249 DOI: 10.1002/pd.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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