Abstract
Objective We aimed to compare costs of two strategies for third-trimester type II vasa previa
management: (1) fetoscopic laser ablation surgery (FLS) referral and (2) standard
management (SM).
Study Design A decision analytic model and cost-benefit analysis from a health care perspective
were performed. The population included patients with type II vasa previa at approximately
32 weeks. SM entailed 32-week antepartum admission and cesarean at approximately 35
weeks. FLS referral included consultation and possible laser surgery at 32 weeks for
willing/eligible candidates. Successful laser surgery allowed the possibility of term
vaginal delivery. Outcomes included antepartum admission, preterm birth, cesarean,
neonatal transfusion, and death. Sensitivity analyses were performed.
Results In base case analysis, FLS referral was cost saving compared with SM (total cost
per patient $65,717.10 vs. 71,628.16). FLS referrals yielded fewer antepartum admissions,
cesareans, premature births, neonatal transfusions, and deaths. Eligible referred
patients choosing FLS incurred a total cost of $41,702.46, a >40% decrease compared
with SM. FLS referral was cost saving in all one-way sensitivity analyses except when
antepartum admission costs were low. In threshold analyses, FLS referral was cost
saving unless laser surgery cost was >$39,892 (2.75x expected cost), antepartum admission
cost for monitoring of vasa previa or ruptured membranes was <$7,455, <11% patients
were eligible for laser surgery, and when <12% of eligible patients chose laser surgery.
In two-way sensitivity analysis, FLS referral was cost saving except at very high
laser surgery costs and extremely low antepartum admission costs.
Conclusion Referral for FLS for type II vasa previa was cost saving and improved outcomes compared
with SM, despite upfront costs, fetoscopy-related risks, and many patients being ineligible
or not opting for surgery after referral.
Key Points
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Vasa previa rupture may lead to fetal exsanguination and death.
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Late preterm cesarean is common practice for prenatally diagnosed vasa previa.
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Successful fetoscopic laser ablation for type II vasa previa has been described.
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Laser ablation of vasa previa allows for a safe-term vaginal delivery.
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Referral for laser surgery is cost saving and is associated with improved outcomes.
Keywords
vasa previa - fetoscopic laser surgery - type II vasa previa - fetal surgery
