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Cost Analysis of Following Up Incomplete Low‐Risk Fetal Anatomy Ultrasounds
Author(s) -
O'Brien Karen,
Shainker Scott A.,
Modest Anna M.,
Spiel Melissa H.,
Resetkova Nina,
Shah Neel,
Hacker Michele R.
Publication year - 2017
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12262
Subject(s) - medicine , ultrasound , cohort , obstetrics , cohort study , retrospective cohort study , fetus , pregnancy , gestation , incidence (geometry) , radiology , surgery , genetics , physics , biology , optics
Objectives To examine the clinical utility and cost of follow‐up ultrasounds performed as a result of suboptimal views at the time of initial second‐trimester ultrasound in a cohort of low‐risk pregnant women. Methods We conducted a retrospective cohort study of women at low risk for fetal structural anomalies who had second‐trimester ultrasounds at 16 to less than 24 weeks of gestation from 2011 to 2013. We determined the probability of women having follow‐up ultrasounds as a result of suboptimal views at the time of the initial second‐trimester ultrasound, and calculated the probability of detecting an anomaly on follow‐up ultrasound. These probabilities were used to estimate the national cost of our current ultrasound practice, and the cost to identify one fetal anomaly on follow‐up ultrasound. Results During the study period, 1,752 women met inclusion criteria. Four fetuses (0.23% [95% CI 0.06–0.58]) were found to have anomalies at the initial ultrasound. Because of suboptimal views, 205 women (11.7%) returned for a follow‐up ultrasound, and one (0.49% [95% CI 0.01–2.7]) anomaly was detected. Two women (0.11%) still had suboptimal views and returned for an additional follow‐up ultrasound, with no anomalies detected. When the incidence of incomplete ultrasounds was applied to a similar low‐risk national cohort, the annual cost of these follow‐up scans was estimated at $85,457,160. In our cohort, the cost to detect an anomaly on follow‐up ultrasound was approximately $55,000. Conclusions The clinical yield of performing follow‐up ultrasounds because of suboptimal views on low‐risk second‐trimester ultrasounds is low. Since so few fetal abnormalities were identified on follow‐up scans, this added cost and patient burden may not be warranted.