Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared outside of the session

CME Credit Offered

Abstract Award

Recording available 2/16-5/2

AIUM Credit

Foundation Awardee

Poster Icons

Abstract Award

Foundation Awardee

Poster Session 2

Category: Prematurity

Poster Session 2

(464) Rescue Antenatal Corticosteroid Administration in Twin Pregnancies: A Cost-Effectiveness Analysis

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Clarice G. Zhou, MD (she/her/hers)

Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States

Coauthor(s)

DS

Dana Senderoff Berger, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States
Diana S. Abbas, MD

Ob/Gyn Resident
Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York, New York, United States
Aaron B. Caughey, MD, PhD

Chair and Professor of Obstetrics and Gynecology
Oregon Health & Science University
Oregon Health & Science University, Oregon, United States
Christina A. Penfield, MD, MPH

Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York City, New York, United States

Objective:
A second course of antenatal corticosteroids (ACS), used for “rescue,” has been shown to be beneficial for fetal maturation in singleton pregnancies at risk of preterm delivery < 34 weeks, but studies have not evaluated the cost-effectiveness of rescue ACS in twin pregnancies. This study aims to evaluate the cost-effectiveness of a rescue course of ACS among twin pregnancies at risk of preterm delivery < 34 weeks.

Study Design:
A cost-effectiveness model was constructed using TreeAge software to compare exposure to one versus two courses of betamethasone in a theoretical cohort of 14,000 twin pregnancies at risk of preterm delivery < 34 weeks in the US per year. The outcomes included in the model were neonatal death and composite respiratory morbidity (including mechanical ventilation, respiratory distress syndrome, and bronchopulmonary dysplasia). Maternal quality-adjusted life years (QALYs) were assessed. All probabilities, utilities, and costs were derived from published literature. Costs are expressed in 2025 US dollars with a willingness to pay threshold (WTP) set at $100,000/QALY. Deterministic and probabilistic sensitivity analyses were performed to interrogate model assumptions.

Results:
In our theoretical cohort of 14,000 twin pregnancies at risk of preterm delivery < 34 weeks gestation, exposure to rescue ACS resulted in 6 fewer neonatal deaths and 1,237 fewer neonates with composite respiratory morbidity. Compared to a single course, rescue ACS was the dominant strategy, resulting in cost savings of $1,026 million and greater effectiveness (33 maternal QALYs). In our sensitivity analyses, we found that administration of rescue ACS remained cost-effective when the probability of respiratory morbidity following a first course was >10%.

Conclusion:
In a theoretical cohort of twin pregnancies < 34 weeks at risk of preterm delivery, a strategy of rescue ACS was associated with improved neonatal outcomes, reduced healthcare costs, and increased maternal QALYs. Rescue ACS, as the dominant strategy, appeared to be a cost-effective intervention in this population.