Evidence map›Paper›PMID 35797108›Full record

ArticleUltrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology2022

Improving antenatal detection of small-for-gestational-age fetus: economic evaluation of Growth Assessment Protocol.

S Relph, M C Vieira, A Copas, K Coxon, A Alagna, A Briley, M Johnson, L Page, D Peebles, A Shennan and 9 more

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Characteristics associated with antenatally unidentified small-for-gestational-age fetuses: prospective cohort study nested within DESiGN randomized controlled trial.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2023
    Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

S RelphDepartment of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.ORCID 0000-0002-2007-9647
M C VieiraDepartment of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
A CopasCentre for Pragmatic Global Health Trials, Institute for Global Health, University College London, London, UK.
K CoxonFaculty of Health, Social Care and Education, Kingston and St George's University, London, UK.
A AlagnaThe Guy's & St Thomas' Charity, London, UK.
A BrileyDepartment of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
M JohnsonDepartment of Surgery and Cancer, Imperial College London, London, UK.
L PageWest Middlesex University Hospital, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
D PeeblesUCL Institute for Women's Health, University College London, London, UK.
A ShennanDepartment of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
B ThilaganathanFetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
N MarlowUCL Institute for Women's Health, University College London, London, UK.
C LeesDepartment of Surgery and Cancer, Imperial College London, London, UK.
D A LawlorPopulation Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
A KhalilFetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.ORCID 0000-0003-2802-7670
J SandallDepartment of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
D PasupathyDepartment of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
A HealeyDepartment of Health Service and Population Research, David Goldberg Centre, King's College London, London, UK.
DESiGN Trial Team

Funding

Medical Research Council MC_UU_00011/6
6 · The paper itself

Abstract

objectiveTo determine whether the Growth Assessment Protocol (GAP), as implemented in the DESiGN trial, is cost-effective in terms of antenatal detection of small-for-gestational-age (SGA) neonate, when compared with standard care.

methodsThis was an incremental cost-effectiveness analysis undertaken from the perspective of a UK National Health Service hospital provider. Thirteen maternity units from England, UK, were recruited to the DESiGN (DEtection of Small for GestatioNal age fetus) trial, a cluster randomized controlled trial. Singleton, non-anomalous pregnancies which delivered after 24 + 0 gestational weeks between November 2015 and February 2019 were analyzed. Probabilistic decision modeling using clinical trial data was undertaken. The main outcomes of the study were the expected incremental cost, the additional number of SGA neonates identified antenatally and the incremental cost-effectiveness ratio (ICER) (cost per additional SGA neonate identified) of implementing GAP. Secondary analysis focused on the ICER per infant quality-adjusted life year (QALY) gained.

resultsThe expected incremental cost (including hospital care and implementation costs) of GAP over standard care was £34 559 per 1000 births, with a 68% probability that implementation of GAP would be associated with increased costs to sustain program delivery. GAP identified an additional 1.77 SGA neonates per 1000 births (55% probability of it being more clinically effective). The ICER for GAP was £19 525 per additional SGA neonate identified, with a 44% probability that GAP would both increase cost and identify more SGA neonates compared with standard care. The probability of GAP being the dominant clinical strategy was low (11%). The expected incremental cost per infant QALY gained ranged from £68 242 to £545 940, depending on assumptions regarding the QALY value of detection of SGA.

conclusionThe economic case for replacing standard care with GAP is weak based on the analysis reported in our study. However, this conclusion should be viewed taking into account that cost-effectiveness analyses are always limited by the assumptions made. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Indexed as

Infant, Newborn, DiseasesState MedicineCost-Benefit AnalysisFemaleFetal Growth RetardationFetusHumansInfant, NewbornInfant, Small for Gestational AgePregnancyRandomized Controlled Trials as Topicantenatal screeningcost-effectivenesseconomic evaluationgrowth assessment protocolSGA

Identifiers

PMID35797108
PMCPMC9828078

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.