(1086) Displaying 1-year Versus Lifetime Pay-offs In the Perinatal Decision Analyses

When the interests of maternal and fetal patients do not align, pregnancy presents a unique challenge to health economic evaluations. The common practice on perinatal topics has been combining all health pay-offs during the lifetime for both mothers and babies in the equation. However, using lifetime evaluation may not truly reflect the complicated decision-making considerations in real-life practice. The objective of this study is to construct a decision tree to compare immediate delivery and expectant management in a hypothetical clinical scenario to compare the preferred decision when 1-year versus lifetime pay-offs are used.

Study Design:

This is a decision analysis in a hypothetical clinical situation when choosing immediate delivery or expectant management is an equipoise. Key assumptions are 1) only one maternal complication is included, its probability is 10% when seeking immediate delivery, while increases to 20% if pregnancy is prolonged for a week, and 25% if prolonged for two weeks; 2) neonatal demise, a short-term complication (i.e. respiratory distress syndrome), and a long-term complication (i.e. developmental delay) are considered for neonatal outcomes. The probabilities of neonatal complications are derived from literature. Quality Adjusted Life Week (QALW) was calculated as a product of utility and duration.

Results:

When maternal complication lasts lifetime, preferred strategies between the 1-year or lifetime evaluation differ at or before 31 weeks. At and after 32 weeks, both evaluation methods favor immediate delivery due to maternal benefits (Table 1). However, when maternal complication is presumed as short-term only, preferred strategies between the 1-year and lifetime evaluation differ almost throughout the span of gestational age.

Conclusion:

Choosing between immediate delivery versus expectant management is a complicated decision that requires balancing the maternal and neonatal risks and benefits. Our study supports individualized consideration when the risk of maternal complication is high, and the impact is long lasting.