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Selective laser photocoagulation versus serial amniodrainage for the treatment of twin-twin transfusion syndrome: a cost-effectiveness analysis

Journal of Perinatology volume 29, pages 543–547 (2009)Cite this article

Abstract

Objective:

To compare the cost-effectiveness of selective laser photocoagulation (SLP) with serial amniodrainage (AD) in the treatment of twin-to-twin transfusion syndrome (TTTS).

Study design:

Using decision-analysis modeling, we compared the cost-effectiveness of using laser photocoagulation with AD for the treatment of TTTS. The analysis was carried out from a societal perspective using a theoretical cohort of 1000 women with TTTS. Costs included the costs of procedures, perinatal complications from TTTS and of resources used for raising a child with cerebral palsy (CP) following TTTS. One-way, multiway and probabilistic (Monte Carlo) sensitivity analyses were carried out for all model variables. The main outcome measures were: cost per quality-adjusted life years (QALYs) gained from treating TTTS.

Result:

On the basis of the available data, the decision model favors SLP as the most cost-effective treatment option compared with AD. Using the theoretical cohort, laser photocoagulation will result in an overall perinatal survival of 59.3% compared with 51.5% for AD. The frequency of children with CP after laser would be 8.5% compared with 15.4% after AD. Sensitivity analyses showed the model to be robust over a wide range of values for the variables, except when the overall survival associated with AD is >62%. Above that survival rate, AD was the more cost-effective therapy.

Conclusion:

Under a wide range of circumstances, the most cost-effective therapy for TTTS is SLP.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University Medical Center, St Louis, MO, USA

    A O Odibo & D M Stamilio

  2. Department of Obstetrics and Gynecology, University of California, San Francisco, CA, USA

    A B Caughey

  3. Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, IL, USA

    W Grobman

  4. Department of Obstetrics and Gynecology, Universitè Versailles, St Quentin, Poissy St Germain, France

    Y Ville

Authors
  1. A O Odibo
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  2. A B Caughey
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  3. W Grobman
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  4. D M Stamilio
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  5. Y Ville
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Corresponding author

Correspondence to A O Odibo.

Additional information

Presented at the 27th Annual Meeting of the Society For Maternal Fetal Medicine, San Francisco

Supplementary Information accompanies the paper on the Journal of Perinatology website (http://www.nature.com/jp)

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Odibo, A., Caughey, A., Grobman, W. et al. Selective laser photocoagulation versus serial amniodrainage for the treatment of twin-twin transfusion syndrome: a cost-effectiveness analysis. J Perinatol 29, 543–547 (2009). https://doi.org/10.1038/jp.2009.39

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