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Intended conservative management versus cesarean hysterectomy for known or suspected placenta accreta spectrum: a cost-effectiveness analysis
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  • Jessica C. Morgan,
  • Erika N. Hripko,
  • Brett Einerson,
  • Ashish Premkumar
Jessica C. Morgan
University of Chicago Department of Obstetrics and Gynecology

Corresponding Author:[email protected]

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Erika N. Hripko
University of Chicago Department of Obstetrics and Gynecology
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Brett Einerson
The University of Utah Department of Obstetrics and Gynecology
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Ashish Premkumar
University of Chicago Department of Obstetrics and Gynecology
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Abstract

Objective: We examined the cost-effectiveness of conservative management (CM) compared to planned cesarean hysterectomy (CH) for placenta accreta spectrum (PAS). Design: A cost-effectiveness analysis in a theoretical cohort of patients. Setting : A decision analytic model. Population : A theoretical cohort of 1000 pregnant patients with PAS greater than 20 weeks gestation. Methods : In base case analysis, we assumed that between 20-40% of individuals would be eligible for CM. Model inputs were derived from the literature. Analysis was conducted from a healthcare system perspective with a one year analytic horizon. Outcomes included hysterectomy, surgical site infection (SSI), length of hospitalization, intensive care unit (ICU) admission, and death. An incremental cost-effectiveness ratio (ICER) of $50,000 per quality-adjusted life year (QALY) defined cost-effectiveness. Sensitivity analyses were performed. Main outcome measures: The cost gained per life year and per QALY. Results: For base-case estimates, CM was the cost-saving strategy with an ICER of $9330.51 USD. Compared to CH, CM resulted in 905 fewer hysterectomies, 80 fewer instances of SSI, and 5 fewer deaths. CM resulted in 149 more admissions with length of stay >5 days and 25 more ICU admissions . In probabilistic sensitivity analysis, CM was the cost-effective strategy in 71% of runs and the dominant strategy in 42% of runs. Conclusion: CM was the cost-effective strategy for management of PAS in greater than 70% of iterations of our model. Modeling demonstrated significant uncertainty in the comparative effectiveness of the two strategies, highlighting the need for prospective research evaluating the effectiveness of CM.
30 May 2024Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
30 May 2024Submission Checks Completed
30 May 2024Assigned to Editor
30 May 2024Review(s) Completed, Editorial Evaluation Pending
08 Jun 2024Reviewer(s) Assigned
02 Oct 2024Editorial Decision: Revise Major
07 Oct 20241st Revision Received
09 Oct 2024Submission Checks Completed
09 Oct 2024Assigned to Editor
09 Oct 2024Review(s) Completed, Editorial Evaluation Pending
17 Nov 2024Editorial Decision: Accept