Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis

Am J Obstet Gynecol. 2010 Jun;202(6):548.e1-8. doi: 10.1016/j.ajog.2009.12.005. Epub 2010 Jan 15.


Objective: The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity.

Study design: We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years, cost in US dollars, and number of preterm births prevented.

Results: Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and was the dominant choice over the 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 alpha-hydroxyprogesterone caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1339 ($8325 vs $9664), when compared with treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the United States.

Conclusion: Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears to be cost-effective and yields the greatest reduction in preterm birth at <34 weeks' gestation.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Administration, Intravaginal
  • Cervical Length Measurement / economics*
  • Cost-Benefit Analysis / economics
  • Decision Support Techniques*
  • Female
  • Humans
  • Obstetrics / economics
  • Pregnancy
  • Premature Birth / economics*
  • Premature Birth / prevention & control*
  • Progesterone / therapeutic use*
  • Progestins / therapeutic use
  • Quality-Adjusted Life Years
  • United States


  • Progestins
  • Progesterone