Carelon Research impact study: Cost effectiveness of a proteomic test for preterm birth prediction

November 2021 | Written by Michael Grabner, PhD

In celebration of the 25th anniversary of Carelon Research Founder’s Day, we’re rolling out a series of articles highlighting some of our most impactful work. These ‘impact studies’ have contributed to the growing evidence base that influences healthcare decision-makers and healthcare policy and practice. They also showcase the diverse service offerings at Carelon Research. Though all our work aims to improve the quality of healthcare, we’re especially proud of this work from research teams across our organization.

Of nearly 4 million babies born annually in the U.S., more than one in 10 is born prematurely. Ref: 2020 March of Dimes Report Card 

Preterm birth (any birth before 37 weeks of gestation) is the leading cause of illness and death in newborns.

In 2019, Carelon Research (formerly HealthCore) uncovered an opportunity to significantly reduce the rate of preterm births and potentially improve millions of lives. Researchers found that a blood test (PreTRM®, Sera Prognostics) used to identify pregnant women who are at higher risk of delivering preterm, combined with clinical interventions, had promise to improve outcomes and lower costs.

Carelon Research (formerly HealthCore) developed an economic model  to evaluate the cost effectiveness of this risk-screening-and-treat strategy, compared to usual care, for a population of commercially insured pregnant women with no known risk factors for preterm birth.

Researchers looked at outcomes from pregnancy start to 12 months post-delivery in mothers and 30 months from birth in infants. Preterm birth rates and costs were based on real-world cohorts of >40,000 mothers and infants with birth events in 2016, as identified in administrative claims.

In the base-case analysis, the risk-screening-and-treat strategy dominated usual care with 870 fewer preterm births (20% reduction) and $54 million less in total costs ($863 net savings per pregnant woman).

Reductions were also seen for neonatal intensive care unit admissions (10%), overall length of stay (7%), and the number of newborns with high morbidity burden (23%). Sensitivity analyses confirmed robustness of the model and showed the importance of treatment effectiveness in assessing whether the risk-screening-and-treat strategy would be cost saving.

This study is one of the first economic evaluations using real-world data to assess the potential value of the PreTRM test for preterm birth risk in a commercially insured US population. More than $850 million could be saved annually assuming full uptake of the risk-screen-and-treat strategy and 4 million births. Such a combination of better outcomes at lower costs is rare in modern healthcare.

Together with Elevance Health and Sera Prognostics, Carelon Research is currently working on the Prematurity Risk Assessment Combined with Clinical Interventions for Improved Neonatal OutcoMEs (PRIME) study : a pragmatic clinical trial that will provide a blueprint for how the healthcare industry can more effectively identify and manage high-risk pregnancies and reduce preterm birth and its sequela.

Contingent on the results of these studies, Elevance Health will be making the test available to pregnant members — more than 10 percent of US pregnancies annually — as part of a multi-year contract with Sera.

The results of this study were presented at Virtual ISPOR  2021 and published in ClinicoEconomics and Outcomes Research .

For more information about our health economics & outcomes research capabilities, including project management, literature reviews, data management, large and complex database analytics, machine learning, patient and provider outreach, medical record review and abstraction, and survey-based-research, visit our Health Economics & Outcomes Research page.

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