OP10.06: First trimester anomaly screening by sonographic tomography compared to conventional two‐dimensional ultrasound: an early‐stage health economic model

Rising healthcare costs and shortages of sonographers necessitate to seek for more efficient ways of first trimester anomaly screening (FTAS). We aimed to explore the potentials of a novel strategy of sonographic tomography (ST), comprising three-dimensional volume acquisition and remote assessment, compared with conventional two-dimensional ultrasound (2D). An early-stage health economic model was developed. A decision tree was designed with input from literature and experts in the field. The model enclosed the period between FTAS and the legal time limit for pregnancy termination. The model was simulated for a theoretical cohort of 180 000 persons (annual number of births in the Netherlands). Outcomes were costs per person (healthcare, productivity, expenses of pregnant person, and total), as well as the total number of structural anomalies detected, false positives and required sonographers. A social perspective was applied. Outcomes were first calculated for a scenario with equal test characteristics. Sensitivity analyses were used to investigate the impact of model parameters on the outcomes. In the sensitivity analysis, the test characteristics of ST were varied in relation to those of 2D. Probabilistic sensitivity analysis was used to address parameter uncertainty. In a scenario with equal test characteristics, total costs for ST per person equal €1064 (95% CI; €1034 to €1099) compared to €1565 (95% CI; €1534 to €1603) for 2D. This comes down to saving €90 000 000 annually in the Netherlands. Sensitivity analysis shows that costs are mainly determined by the specificity. In all investigated scenarios, ST is less costly, except if specificity is >30% lower than 2D. Sensitivity barely influences costs. ST would require 28.5% less FTE sonographers. ST might improve the efficiency of FTAS. High specificity is necessary for cost saving and high sensitivity is important to detect anomalies. Research of both strategies is needed to estimate consequences more precisely.