Cost effectiveness of a proteomic test for preterm birth prediction

In the U.S., the prevalence of preterm birth is high, and the health challenges that arise from it are significant. Carelon business HealthCore has uncovered a blueprint for how the healthcare system can reduce its incidence and better manage high-risk pregnancies.

Preterm birth (any birth before 37 weeks' gestation) is the leading cause of illness and death in newborns. According to the 2020 March of Dimes Report Card1  of nearly 4 million babies born annually in the U.S., more than one in 10 is born prematurely.

In 2019, HealthCore uncovered an opportunity to significantly reduce the rate of preterm births and potentially improve millions of lives. Researchers found that a blood test (PreTRM®, Sera Prognostics) used to identify pregnant women who are at higher risk of delivering preterm, combined with clinical interventions, had promise to improve outcomes and lower costs.

In the base-case analysis, the risk-screening-and-treat strategy dominated usual care with 870 fewer preterm births (20% reduction) and $54 million less in total costs ($863 net savings per pregnant woman).

Assessing the value of the risk-screening-and-treat strategy

HealthCore developed an economic model2 to evaluate the cost-effectiveness of this risk-screening-and-treat strategy, compared to usual care, for a population of commercially insured pregnant women with no known risk factors for preterm birth.

Researchers looked at outcomes from pregnancy starting to 12 months post-delivery in mothers and 30-months from birth in infants. Preterm birth rates and costs were based on real-world cohorts of >40,000 mothers and infants with birth events in 2016, as identified in administrative claims.

Reductions were also seen for neonatal-intensive-care-unit admissions (10%), overall length-of-stay (7%), and the number of newborns with high morbidity burden (23%). Sensitivity analyses confirmed robustness of the model and showed the importance of treatment effectiveness in assessing whether the risk-screening-and-treat strategy would be cost-saving.

This study is one of the first economic evaluations using real-world data to assess the potential value of the PreTRM test for preterm birth risk in a commercially insured US population. More than $850 million could be saved annually assuming full uptake of the risk-screen-and-treat strategy and four million births. Such a combination of better outcomes at lower costs is rare in modern healthcare.

The future and the impact of HealthCore’s preterm-birth research

Together with Anthem and Sera Prognostics, HealthCore is currently working on the Prematurity Risk Assessment Combined with Clinical Interventions for Improved Neonatal OutcoMEs (PRIME) study3 a pragmatic clinical trial that will provide a blueprint for how the healthcare industry can more effectively identify and manage high-risk pregnancies and reduce preterm birth and its sequela.

Contingent on the results of these studies, Anthem will be making the test available to pregnant members — more than 10 percent of US pregnancies annually — as part of a multi-year contract with Sera.

The results of this study were presented at Virtual ISPOR 20214 and published in ClinicoEconomics and Outcomes Research5.

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