Cost‐effectiveness of implementing a multidisciplinary team approach in the management of placenta accreta spectrum
Binh T. Luu, Megha Arora, Ava D. Mandelbaum, Andrew H. Chon, Tania F. Esakoff, Deirdre J. Lyell, Aaron B. CaugheyAbstract
Objective
Placenta accreta spectrum (PAS) is associated with high maternal morbidity. Recent studies have shown that a multidisciplinary team (MDT) approach to managing PAS can improve outcomes. This study aimed to evaluate the cost‐effectiveness of implementing an MDT for the management of PAS.
Methods
A decision‐analytic model was built using TreeAge software to compare the outcomes and cost‐effectiveness of the MDT approach versus the standard of care. The theoretical cohort included 5000 individuals in the United States with PAS annually. Maternal outcomes included severe postpartum hemorrhage (>2000 mL estimated blood loss), adjacent organ injury, intensive care unit (ICU) admission, maternal death, and hospital readmission. The cost of the MDT was estimated by assuming that there would be specific maternal‐fetal medicine (MFM) physician and nursing leadership assigned for administrative coordination and estimates of the cost of the multidisciplinary clinicians during the PAS cases. 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
An MDT approach for the management of PAS resulted in 3724 fewer severe postpartum hemorrhages, 139 fewer adjacent organ injuries, 506 fewer ICU admissions, 87 fewer hospital readmissions within 6 months, and one less maternal death compared to standard of care. When assuming a minimum baseline of 15 PAS cases per year, the MDT approach was a dominant strategy resulting in a $12.1 million cost reduction and an increase of 26 QALYs relative to standard care. One‐way sensitivity analyses on the cost of the MDT per PAS case and the number of PAS cases per medical center demonstrated that the MDT strategy remains cost effective when the cost per case was less than $9290 and when centers treat at least seven PAS cases annually.
Conclusion
Implementing an MDT was cost effective and improved maternal outcomes. These findings may inform interventions that promote MDT in the management of this high‐risk condition.