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254: Cost effectiveness analysis of MCA Dopplers after 34 weeks gestation for Kell alloimmunization during pregnancy
Poster Session I SGA (42.9 vs. 30.0%). However, 95% confidence intervals overlapped (Table 1). Specificity between NICHD and Hadlock were similar. Both charts similarly identified low numbers of fetuses who subsequently were admitted to the NICU, had pH less than 7.2 or 5 minute Apgar of less than 7. When FGR was defined at less than 10th%, the sensitivity to detect an FGR fetus who subsequently developed SGA was similar among NICHD and Hadlock standards. NICU admissions, pH of less than 7.2 and 5 minute Agpar of less than 7 were also similar among groups when FGR was defined at less than 10th%. CONCLUSION: Although the Hadlock’s chart appears to diagnose more cases of neonatal SGA, short-term outcomes appear similar to the NICHD standard. Differences in long-term outcomes between standards are unknown.
ajog.org The optimal intervention was that which achieved the greatest number of QALYs. Cost-effectiveness was defined at a threshold of $100,000 per QALY. Univariate sensitivity analyses were used to investigate robustness of the model. RESULTS: Expectant management with induction of labor at 37 weeks gestation led to better outcomes when considering neonatal death, pre-term birth, CP, NDD and maximizing total QALYs (Table). In a theoretical cohort of 12,800 mother-baby dyads, expectant management until 37 weeks without MCA Dopplers resulted in 3 fewer cases of neonatal death, 5 fewer cases of CP, and 138 fewer cases of NDD resulting in cost savings of over $515 million healthcare dollars compared to weekly MCA Dopplers with delivery at 37 weeks. Sensitivity analysis confirms that QALYs are maximized with expectant management until 37 weeks assuming the incidence of anemia is less than 1.4% (Figure). CONCLUSION: Expectant management after 34 weeks without MCA Dopplers in the Kell alloimmunized pregnancy may lead to less iatrogenic deliveries and decreased incidence of neonatal death, CP, NDD and better utilization of healthcare dollars. Incorporating these findings into health systems caring for alloimmunized women should be considered.
254 Cost effectiveness analysis of MCA Dopplers after 34 weeks gestation for Kell alloimmunization during pregnancy Scott W. Hoffmann1, Catherine S. John1, Kelly Kuo1, Brian L. Shaffer1, Alison G. Cahill2, Aaron B. Caughey1 1 Oregon Health & Science University, Portland, OR, 2Washington University in St. Louis, St. Louis, MO
OBJECTIVE: Middle cerebral artery (MCA) Dopplers to detect fetal anemia in pregnancies with Kell alloimmunization is the standard of care, however evidence suggests that the test sensitivity decreases after 34 weeks. Few studies have analyzed the efficacy of MCA Dopplers at >34 weeks, leaving clinicians to weigh the risk of early iatrogenic delivery against development of fetal anemia and hydrops fetalis. We sought to determine if weekly MCA Dopplers after 34 weeks was associated with lower neonatal and maternal morbidity and if this was cost-effective compared to expectant management. STUDY DESIGN: A decision-analytic model was constructed using TreeAge software to compare weekly MCA Dopplers and delivery at 36, 37, and 38 weeks vs. expectant management with delivery at 36, 37, and 38 weeks in Kell alloimmunized pregnancies. Outcomes included rates of anemia, hydrops, IUFD, neonatal death, preterm birth (<37 weeks), cerebral palsy (CP), neurodevelopmental delay (NDD), and total quality-adjusted life years (QALYs). Probabilities, costs and utilities for each outcome were derived from the literature.
255 The hepatic circadian gene npas2 regulates satiety and obesity in response to a high-fat diet Derek O’Neil, Danielle Goodspeed, Cynthia Shope, Kjersti Aagaard Baylor College of Medicine, HOUSTON, TX
OBJECTIVE: Despite being in an environment absent of light-dark
signals, the fetus establishes and then maintains its circadian rhythms. Previously, we have demonstrated that a maternal high-fat diet is associated with the disruption of a key peripheral circadian gene (Npas2) in the fetal liver. In a novel Npas2 cKO mouse model of the peripheral clock (liver) we have shown that Npas2 cKO mice
S158 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
ajog.org The optimal intervention was that which achieved the greatest number of QALYs. Cost-effectiveness was defined at a threshold of $100,000 per QALY. Univariate sensitivity analyses were used to investigate robustness of the model. RESULTS: Expectant management with induction of labor at 37 weeks gestation led to better outcomes when considering neonatal death, pre-term birth, CP, NDD and maximizing total QALYs (Table). In a theoretical cohort of 12,800 mother-baby dyads, expectant management until 37 weeks without MCA Dopplers resulted in 3 fewer cases of neonatal death, 5 fewer cases of CP, and 138 fewer cases of NDD resulting in cost savings of over $515 million healthcare dollars compared to weekly MCA Dopplers with delivery at 37 weeks. Sensitivity analysis confirms that QALYs are maximized with expectant management until 37 weeks assuming the incidence of anemia is less than 1.4% (Figure). CONCLUSION: Expectant management after 34 weeks without MCA Dopplers in the Kell alloimmunized pregnancy may lead to less iatrogenic deliveries and decreased incidence of neonatal death, CP, NDD and better utilization of healthcare dollars. Incorporating these findings into health systems caring for alloimmunized women should be considered.
254 Cost effectiveness analysis of MCA Dopplers after 34 weeks gestation for Kell alloimmunization during pregnancy Scott W. Hoffmann1, Catherine S. John1, Kelly Kuo1, Brian L. Shaffer1, Alison G. Cahill2, Aaron B. Caughey1 1 Oregon Health & Science University, Portland, OR, 2Washington University in St. Louis, St. Louis, MO
OBJECTIVE: Middle cerebral artery (MCA) Dopplers to detect fetal anemia in pregnancies with Kell alloimmunization is the standard of care, however evidence suggests that the test sensitivity decreases after 34 weeks. Few studies have analyzed the efficacy of MCA Dopplers at >34 weeks, leaving clinicians to weigh the risk of early iatrogenic delivery against development of fetal anemia and hydrops fetalis. We sought to determine if weekly MCA Dopplers after 34 weeks was associated with lower neonatal and maternal morbidity and if this was cost-effective compared to expectant management. STUDY DESIGN: A decision-analytic model was constructed using TreeAge software to compare weekly MCA Dopplers and delivery at 36, 37, and 38 weeks vs. expectant management with delivery at 36, 37, and 38 weeks in Kell alloimmunized pregnancies. Outcomes included rates of anemia, hydrops, IUFD, neonatal death, preterm birth (<37 weeks), cerebral palsy (CP), neurodevelopmental delay (NDD), and total quality-adjusted life years (QALYs). Probabilities, costs and utilities for each outcome were derived from the literature.
255 The hepatic circadian gene npas2 regulates satiety and obesity in response to a high-fat diet Derek O’Neil, Danielle Goodspeed, Cynthia Shope, Kjersti Aagaard Baylor College of Medicine, HOUSTON, TX
OBJECTIVE: Despite being in an environment absent of light-dark
signals, the fetus establishes and then maintains its circadian rhythms. Previously, we have demonstrated that a maternal high-fat diet is associated with the disruption of a key peripheral circadian gene (Npas2) in the fetal liver. In a novel Npas2 cKO mouse model of the peripheral clock (liver) we have shown that Npas2 cKO mice
S158 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017