Budget impact analysis of cervical length measurement during the routine second trimester anomaly scan for the prevention of spontaneous preterm birth in the Netherlands

Objective: To assess the budget impact of implementing cervical length (CL) measurement during the routine second trimester anomaly scan, combined with progesterone treatment if needed, to prevent spontaneous preterm birth (sPTB) in low-risk pregnancies in the Netherlands. Design: A budget impact analysis was conducted comparing two strategies for asymptomatic women with singleton pregnancies and no history of sPTB before 34 weeks of gestation: (1) no CL measurement or progesterone treatment, and (2) universal CL measurement with subsequent progesterone treatment for women identified with a short cervix. Data was derived from the Netherlands Perinatal Registry. Standard costs were obtained from Dutch healthcare costing guidelines. We included costs of CL measurement, progesterone treatment, and peri- and neonatal care. A probabilistic sensitivity analysis using Monte Carlo simulation assessed uncertainty. Results: The analysis showed a decrease in costs as the implementation rate of CL measurement increased. With 100 % implementation, total annual costs were €44,559,472, compared to €49,533,621 with no implementation, resulting in a budget impact of −€4,974,149 per year. The largest savings were in neonatal care costs, especially for infants born before 28 weeks of gestation. The CL measurement group incurred €17,111,863 in neonatal care costs, compared to €23,516,862 for the no CL measurement group (difference − €6,404,999). Conclusion: These findings indicate that implementation of CL measurement results in substantial annual cost savings, particularly in neonatal care costs. Therefore, implementing universal CL measurement during the routine second trimester anomaly scan at the national level should be strongly considered.