Ultrasound during pregnancy - A representative Swiss national survey

Background: The cost-effectiveness ratio of routine ultrasound during pregn ancy has been debated for years. However, there is a lack of population bas ed data concerning both costs and benefit. Aim: Population based survey of ultrasound examinations (US) during pregnan cy in Switzerland with respect to quantity, indications and results; estima tion of total costs, the proportion paid by health insurance and the costs for routine US. Method: During a representative week all certified physicians and obstetric al out-patient departments in Switzerland were asked to participate in an a nonymous questionnaire based national survey on the use of ultrasound durin g pregnancy. Results: With 62.9% of the physicians and 90.6% of the out-patient departme nts participating a total of 6455 questionnaires were returned. On average, 4.6 US were done per pregnancy or about 520 000 scans per year. At a mean price of $ 50 per scan total costs equalled $ 26 million a year. $ 19.5 mil lion were covered by health insurance and the rest was not billed by the ph ysicians. The indication for the scan was a medical problem in 48%, a routi ne scan in 36.9% of cases a first and a second trimester scan is paid for a nd in 15.1% reassurance of either the women or the physician. Abnormal resu lts were found in 40.7% of medical indications, in 15% of routine scans and in 12.6% of reassurance cases. Conclusion: The considerable number of scans done for reasons of reassuranc e and not changed for does support our hypothesis that ultrasound during pr egnancy has become a tool to routinely check the general state of the fetus comparable to the stethoscope of the general practitioner. One in seven US yielded a pathological result. Maximal cost savings for the health insuran ce amount to about 9 million a year. This amount has to be balanced by the health benefit, respectively if routine US were abolished.