COST-EFFECTIVENESS OF FETAL LUNG MATURITY TESTING IN PRETERM LABOR

Objective: To determine the marginal cost-effectiveness of two strateg ies for preventing respiratory distress syndrome (RDS) resulting from preterm birth: 1) tocolysis with beta mimetic agonists and treatment w ith corticosteroids (TREATALL), and 2) amniocentesis and testing for f etal lung maturity, with treatment based on test results (TESTALL), co mpared with no treatment. Methods: We used a Markov decision analytic model to estimate the outcomes of each strategy, from a hospital-based perspective. Probability variables were obtained from the literature, whereas cost variables came from the Beth Israel-Deaconess Medical Ce nter. Sensitivity analysis was performed on all variables.Results: The most cost-effective strategy varied with the probability of RDS. TREA TALL was the most cost-effective strategy above a probability of 17% ( before 34 weeks' gestation), TESTALL was most cost-effective from 17% to 2% (34-36 weeks), and it was most cost-effective to use no treatmen t at probabilities less than 2% (after 36 weeks). TREATALL and TESTALL were both cost-saving compared with no treatment at probabilities of RDS above 2%. TREATALL was more highly favored as the costs of RDS and preterm birth increased, whereas TESTALL was more favored as the spec ificity of the test and the cost of maternal hospitalization increased . Conclusion: Although testing for fetal lung maturity is useful in ma ny clinical situations, the cost-effectiveness of such testing in the setting of idiopathic preterm labor from a tertiary medical center per spective depends primarily on the probability and costs of RDS and the costs of non-RDS-related morbidity. At our institution, such testing is cost-effective between 34 and 36 weeks' gestation. (C) 1997 by The American College of Obstetricians and Gynecologists.