(712) Cost-effectiveness of implementing a multidisciplinary team approach the management of placenta accreta spectrum

Objective: Placenta accreta spectrum (PAS) is associated with high maternal morbidity. Recent studies have shown that a multidisciplinary team approach to managing PAS can improve outcomes. This study aimed to evaluate the cost-effectiveness of implementing a multidisciplinary team for the management of PAS.

Study Design:

Methods: A decision-analytic model was built using TreeAge software to compare the outcomes and cost-effectiveness of the multidisciplinary team approach versus standard of care (i.e. without immediate availability of a gynecologic oncologist, anesthesiologist, etc.) The theoretical cohort included 5,000 individuals in the U.S. with PAS. Maternal outcomes included severe postpartum hemorrhage ( >2000 mL estimated blood loss), adjacent organ injury, ICU admission, maternal death, and hospital readmission. The cost of the multidisciplinary team was estimated by assuming there would be specific MFM physician and nursing leadership assigned. Model inputs were derived from the literature. The cost-effectiveness threshold was $100,000/quality-adjusted life-year (QALY). Sensitivity analyses were performed to assess the robustness of the results.

Results:

Results: A multidisciplinary team approach for the management of PAS resulted in 3,724 fewer severe postpartum hemorrhages, 139 fewer adjacent organ injuries, 506 fewer ICU admissions, 87 fewer hospital readmissions within 6 months, and 1 fewer maternal death compared to standard of care (Table 1). When assuming a minimum baseline of 15 PAS cases per year, the multidisciplinary team approach was a dominant strategy resulting in a $8.8 million cost reduction and an increase of 59 QALYs relative to standard care. A one-way sensitive analysis on the number of PAS cases per medical center demonstrated the multidisciplinary team strategy remains cost-effective when centers treat ³ 8 PAS cases annually (Figure 1).

Conclusion:

Conclusion: Implementing a multidisciplinary team was cost-effective and improved maternal outcomes. These findings may inform interventions that promote multidisciplinary teams in the management of this high-risk condition.