Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


32845.pdf (2.4 MB)

ETD Abstract Container

Abstract Header

Prenatal Heart Block Screening in Mothers With SSA/SSB Auto-antibodies: Targeted Screening Protocol is a Cost-Effective Strategy

Evers, Patrick D., M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552379621451565

Abstract Details

2019, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Objective: Maternal anti-Ro/SSA and anti-La/SSB antibodies can lead to fetal complete heart block (CHB). Current guidelines recommend weekly echocardiographic screening between 16 and 28 weeks gestation. Given the cost of screening and the rarity of conduction abnormalities in fetuses of mothers with low anti-Ro levels (<50U/mL), we sought to identify a strategy that optimizes resource utilization. Design: Decision analysis cost-utility modeling was performed for 3 screening paradigms: “standard screening” (SS) in which mid-gestation mothers are screened weekly, “limited screening” (LS) in which fetal echocardiograms are avoided unless the fetus develops bradycardia, and “targeted screening by maternal antibody level” (TS) in which only high anti-Ro values warrant weekly screening. A systematic review of existing literature and institutional cost data were used to define model inputs. Results: The average cost of LS, TS, and SS was $8,566, $11,038, and $23,279, respectively. Standard Screening was cost-ineffective with an incremental cost-effectiveness ratio (ICER) of $322,756 while TS was cost-effective with an ICER of $43,445. Conclusion: While the efficacy of fetal intervention for 1st or 2nd degree AV block remains unclear, this analysis supports utilizing antibody levels to stratify this population for optimized surveillance for CHB. Standard Screening is cost-ineffective and results in resource overutilization.
Aimin Chen, Ph.D. (Committee Chair)
Allison Divanovic (Committee Member)
18 p.
Surgery
Neonatal Systemic Lupus Erythematosus; complete heart block; cost-utility

Recommended Citations

Citations

  • Evers, M.D., P. D. (2019). Prenatal Heart Block Screening in Mothers With SSA/SSB Auto-antibodies: Targeted Screening Protocol is a Cost-Effective Strategy [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552379621451565

    APA Style (7th edition)

  • Evers, M.D., Patrick. Prenatal Heart Block Screening in Mothers With SSA/SSB Auto-antibodies: Targeted Screening Protocol is a Cost-Effective Strategy. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552379621451565.

    MLA Style (8th edition)

  • Evers, M.D., Patrick. "Prenatal Heart Block Screening in Mothers With SSA/SSB Auto-antibodies: Targeted Screening Protocol is a Cost-Effective Strategy." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552379621451565

    Chicago Manual of Style (17th edition)

ucin1552379621451565
618
© 2019, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.