MS, University of Cincinnati, 2019, 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.

Committee: Aimin Chen Ph.D. (Committee Chair); Allison Divanovic (Committee Member) Subjects: Surgery