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Am J Perinatol 2024; 41(S 01): e2454-e2462
DOI: 10.1055/s-0043-1771262
Original Article

Fetoscopic Laser Ablation of Type II Vasa Previa: A Cost Benefit Analysis

Martha A. Monson 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City, Utah
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Ramen H. Chmait
3   Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Brett Einerson
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City, Utah
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
› Author Affiliations Funding B.E. was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under award number K23HD106009 during the completion of this work.
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Abstract

Objective We aimed to compare costs of two strategies for third-trimester type II vasa previa management: (1) fetoscopic laser ablation surgery (FLS) referral and (2) standard management (SM).

Study Design A decision analytic model and cost-benefit analysis from a health care perspective were performed. The population included patients with type II vasa previa at approximately 32 weeks. SM entailed 32-week antepartum admission and cesarean at approximately 35 weeks. FLS referral included consultation and possible laser surgery at 32 weeks for willing/eligible candidates. Successful laser surgery allowed the possibility of term vaginal delivery. Outcomes included antepartum admission, preterm birth, cesarean, neonatal transfusion, and death. Sensitivity analyses were performed.

Results In base case analysis, FLS referral was cost saving compared with SM (total cost per patient $65,717.10 vs. 71,628.16). FLS referrals yielded fewer antepartum admissions, cesareans, premature births, neonatal transfusions, and deaths. Eligible referred patients choosing FLS incurred a total cost of $41,702.46, a >40% decrease compared with SM. FLS referral was cost saving in all one-way sensitivity analyses except when antepartum admission costs were low. In threshold analyses, FLS referral was cost saving unless laser surgery cost was >$39,892 (2.75x expected cost), antepartum admission cost for monitoring of vasa previa or ruptured membranes was <$7,455, <11% patients were eligible for laser surgery, and when <12% of eligible patients chose laser surgery. In two-way sensitivity analysis, FLS referral was cost saving except at very high laser surgery costs and extremely low antepartum admission costs.

Conclusion Referral for FLS for type II vasa previa was cost saving and improved outcomes compared with SM, despite upfront costs, fetoscopy-related risks, and many patients being ineligible or not opting for surgery after referral.

Key Points

  • Vasa previa rupture may lead to fetal exsanguination and death.

  • Late preterm cesarean is common practice for prenatally diagnosed vasa previa.

  • Successful fetoscopic laser ablation for type II vasa previa has been described.

  • Laser ablation of vasa previa allows for a safe-term vaginal delivery.

  • Referral for laser surgery is cost saving and is associated with improved outcomes.

Keywords

vasa previa - fetoscopic laser surgery - type II vasa previa - fetal surgery

Note

This abstract was presented in virtual poster form at the Society for Maternal Fetal Medicine 42nd Annual Pregnancy Meeting.


Authors' Contributions

M.A.M., R.H.C., and B.E. provided significant contributions to the writing of the manuscript and in model development. All authors were involved in model parameter development. B.E. performed model analyses. All authors reviewed the final version of the manuscript.


Ethical Approval

This study was approved by the Institutional Review Board of the University of Southern California for the Health Sciences campus, approval number HS-16-00468. Local institutional data were utilized in part to inform probability and cost parameters for this cost-benefit analysis, where written informed consent was obtained from participants to participate in this study.


Data Availability Statement

Probability and cost parameters were derived from published literature as cited in this manuscript in combination with local institutional data. Further details regarding probability and cost parameters utilized as well as details pertaining to the decision tree model and sensitivity analyses performed may be requested from the corresponding author (M.A.M.) upon reasonable request.




Publication History

Received: 22 May 2023

Accepted: 20 June 2023

Article published online:
21 July 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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