{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:33:17Z","timestamp":1792888397826,"version":"4.5.0"},"reference-count":63,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":0,"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":[[2021,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To determine if a policy of universal fetal echocardiography (echo) in pregnancies conceived by\n                      <jats:italic>in\u2010vitro<\/jats:italic>\n                      fertilization (IVF) is cost\u2010effective as a screening strategy for congenital heart defects (CHDs) and to examine the cost\u2010effectiveness of various other CHD screening strategies in IVF pregnancies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision\u2010analysis model was designed from a societal perspective with respect to the obstetric patient, to compare the cost\u2010effectiveness of three screening strategies: (1) anatomic ultrasound (US): selective fetal echo following abnormal cardiac findings on detailed anatomic survey; (2) intracytoplasmic sperm injection (ICSI) only: fetal echo for all pregnancies following IVF with ICSI; (3) all IVF: fetal echo for all IVF pregnancies. The model initiated at conception and had a time horizon of 1\u2009year post\u2010delivery. The sensitivities and specificities for each strategy, the probabilities of major and minor CHDs and all other clinical estimates were derived from the literature. Costs, including imaging, consults, surgeries and caregiver productivity losses, were derived from the literature and Medicare databases, and are expressed in USA dollars ($). Effectiveness was quantified as quality\u2010adjusted life years (QALYs), based on how the strategies would affect the quality of life of the obstetric patient. Secondary effectiveness was quantified as number of cases of CHD and, specifically, cases of major CHD, detected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average base\u2010case cost of each strategy was as follows: anatomic\u2009US, $8119; ICSI\u2009only, $8408; and all\u2009IVF, $8560. The effectiveness of each strategy was as follows: anatomic\u2009US, 1.74487 QALYs; ICSI\u2009only, 1.74497 QALYs; and all\u2009IVF, 1.74499 QALYs. The ICSI\u2010only strategy had an incremental cost\u2010effectiveness ratio (ICER) of $2\u2009840\u2009494 per additional QALY gained when compared to the anatomic\u2010US strategy, and the all\u2010IVF strategy had an ICER of $5\u2009692\u2009457 per additional QALY when compared with the ICSI\u2010only strategy. Both ICERs exceeded considerably the standard willingness\u2010to\u2010pay threshold of $50\u2009000\u2013$100\u2009000 per QALY. In a secondary analysis, the ICSI\u2010only strategy had an ICER of $527\u2009562 per additional case of major CHD detected when compared to the anatomic\u2010US strategy. All\u2009IVF had an ICER of $790\u2009510 per case of major CHD detected when compared with ICSI\u2009only. It was determined that it would cost society five times more to detect one additional major CHD through intensive screening of all IVF pregnancies than it would cost to pay for the neonate's first year of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The most cost\u2010effective method of screening for CHDs in pregnancies following IVF, either with or without ICSI, is to perform a fetal echo only when abnormal cardiac findings are noted on the detailed anatomy scan. Performing routine fetal echo for all IVF pregnancies is not cost\u2010effective. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.22048","type":"journal-article","created":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T14:34:55Z","timestamp":1587220495000},"page":"979-986","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Cost\u2010effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by\n                    <i>in\u2010vitro<\/i>\n                    fertilization"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7593-3719","authenticated-orcid":false,"given":"E. H.","family":"Chung","sequence":"first","affiliation":[{"name":"Duke University, Department of Obstetrics and Gynecology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. L.","family":"Lim","sequence":"additional","affiliation":[{"name":"Duke University, Department of Obstetrics and Gynecology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. J.","family":"Havrilesky","sequence":"additional","affiliation":[{"name":"Duke University, Department of Obstetrics and Gynecology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Z.","family":"Steiner","sequence":"additional","affiliation":[{"name":"Duke University, Department of Obstetrics and Gynecology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. K.","family":"Dotters\u2010Katz","sequence":"additional","affiliation":[{"name":"Duke University, Department of Obstetrics and Gynecology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6606a1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008095"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmt006"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23355"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2005.03.086"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010035"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.12.001"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.02.053"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18932"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000064"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001643"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1414"},{"key":"e_1_2_7_14_1","unstructured":"UNC. 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