{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:29:25Z","timestamp":1765758565623,"version":"3.40.5"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the cost\u2010effectiveness of cervical pessary <jats:italic>vs<\/jats:italic> vaginal progesterone to prevent preterm birth and neonatal morbidity in women with twin pregnancy and a short cervix.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 4 March 2016 and 3 June 2017, we performed this economic analysis following a randomized controlled trial (RCT), performed at My Duc Hospital, Ho Chi Minh City, Vietnam, that compared cervical pessary to vaginal progesterone in women with twin pregnancy and cervical length &lt;\u200938\u2009mm between 16 and 22\u2009weeks of gestation. We used morbidity\u2010free neonatal survival as a measure of effectiveness. Data on pregnancy outcome, maternal morbidity and neonatal complications were collected prospectively from medical files; additional information was obtained via telephone interviews with the patients. The incremental cost\u2010effectiveness ratio was calculated as the incremental cost required to achieve one extra surviving morbidity\u2010free neonate in the pessary group compared with in the progesterone group. Probabilistic and one\u2010way sensitivity analyses were also performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, we screened 1113 women with twin pregnancy, of whom 300 fulfilled the inclusion criteria of the RCT and gave informed consent to participate. These women were assigned randomly to receive cervical pessary (<jats:italic>n<\/jats:italic>\u2009=\u2009150) or vaginal progesterone (<jats:italic>n<\/jats:italic>\u2009=\u2009150), with two women and one woman, respectively, being lost to follow\u2010up. The rate of morbidity\u2010free neonatal survival was significantly higher in the pessary group compared with the progesterone group (<jats:italic>n<\/jats:italic>\u2009=\u2009241\/296 (81.4%) <jats:italic>vs<\/jats:italic> 219\/298 (73.5%); relative risk, 1.11 (95%\u2009CI, 1.02\u20131.21), <jats:italic>P<\/jats:italic>\u2009=\u20090.02). The mean total cost per woman was 3146\u2009\u20ac in the pessary group <jats:italic>vs<\/jats:italic> 3570\u2009\u20ac in the progesterone group (absolute difference, \u2013424\u2009\u20ac (95%\u2009CI, \u2013842 to \u20133\u2009\u20ac), <jats:italic>P<\/jats:italic>\u2009=\u20090.048). The cost per morbidity\u2010free neonate was significantly lower in the pessary group compared with that in the progesterone group (2492 <jats:italic>vs<\/jats:italic> 2639\u2009\u20ac; absolute difference, \u2013147\u2009\u20ac (95%\u2009CI, \u2212284 to 10\u2009\u20ac), <jats:italic>P<\/jats:italic>\u2009=\u20090.035).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In women with twin pregnancy and a short cervix, cervical pessary improves significantly the rate of morbidity\u2010free neonatal survival while reducing costs, as compared with vaginal progesterone. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20848","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T05:13:31Z","timestamp":1566364411000},"page":"339-347","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cervical pessary <i>vs<\/i> vaginal progesterone for prevention of preterm birth in women with twin pregnancy and short cervix: economic analysis following randomized controlled trial"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3236-2044","authenticated-orcid":false,"given":"K. D.","family":"Le","sequence":"first","affiliation":[{"name":"HOPE Research Center  Ho Chi Minh City Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. K.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"My Duc Hospital  Ho Chi Minh City Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. T. M.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"My Duc Hospital  Ho Chi Minh City Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. W. J.","family":"Mol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Monash University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V. Q.","family":"Dang","sequence":"additional","affiliation":[{"name":"HOPE Research Center  Ho Chi Minh City Vietnam"},{"name":"My Duc Hospital  Ho Chi Minh City Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60136-1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61698-6"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14832"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149252"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340904"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1998.12050312.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.11.001"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13575"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03448.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13032"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.11.012"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61408-7"},{"issue":"3","key":"e_1_2_7_14_1","first-page":"e1","article-title":"Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial","volume":"214","author":"Nicolaides KH","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17430"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2016.1268595"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003136"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2015.02.001"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f1049"},{"key":"e_1_2_7_20_1","article-title":"Exchange rate June 2016. 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