(1030) Cost-effectiveness of early fetal anomaly screening (11-14 weeks) in pregnancies complicated by pregestational diabetes mellitus

Objective:
Second trimester anomaly screening is currently the standard-of-care for the general population, although many congenital anomalies can already be detected in the first trimester of pregnancy via ultrasound. This results in some abnormalities being identified later in the second trimester, when pregnancy termination may no longer be an option and is associated with greater cost and risk. This study aims to investigate the cost-effectiveness of first-trimester anomaly screening in pregestational diabetes, which is a high-risk condition with an elevated prevalence of fetal anomalies, by enabling earlier decisions regarding pregnancy termination or fetal intervention.

Study Design:
We designed a decision-analytic model using TreeAge Pro 2025 software to compare first trimester vs. second trimester ultrasound screening for a theoretical cohort of 31,347 women with pre-gestational diabetes mellitus. The average cost for a fetal anatomy scan was $497. Primary outcomes were 1st trimester scan anomaly detection rate, total anomalies correctly detected, pregnancy loss, NICU stay, neonatal mortality, cost, and quality-adjusted life years (QALYs). Model inputs were obtained from the literature and varied in sensitivity analyses, with a cost-effectiveness threshold of $100,000/QALY.

Results:
In our theoretical cohort of 31,347 pregnant persons with pregestational DM, a total of 380 more anomalies were detected in the first trimester strategy when compared to the standard-of-care second trimester strategy. Regarding neonatal outcomes, there were 337 less pregnancy losses, 113 less NICU stays, and 69 less cases of neonatal mortality in the 1st trimester group. These outcomes led to a $47,872,412 reduction in cost and 344 additional QALYs in the first-trimester strategy compared to the second-trimester strategy.

Conclusion:
Early fetal anomaly screening for women with pregestational diabetes resulted in lower costs and higher QALYs, representing a dominant strategy that was cost-effective.