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The model was constructed as a combined decision\u2010tree model and Markov model with a time horizon of 100\u2009years. Four preventive strategies, namely \u2018Universal screening\u2019, \u2018High\u2010risk\u2010based screening\u2019 (i.e. screening of high\u2010risk women only), \u2018Low\u2010risk\u2010based screening\u2019 (i.e. treatment of high\u2010risk population and screening of remaining women) and \u2018Nullipara screening\u2019 (i.e. treatment of high\u2010risk population and screening of nulliparous women only), included second\u2010trimester cervical length (CL) screening by transvaginal ultrasound followed by vaginal progesterone treatment in the case of a short cervix. A fifth preventive strategy involved vaginal progesterone treatment of women with previous spontaneous PTD or late miscarriage but no CL screening (\u2018No screening, treat high\u2010risk group\u2019). For comparison, we used a sixth strategy implying no specific intervention to prevent spontaneous PTD, reflecting the current situation in Sweden (\u2018No screening\u2019). Probabilities for a short cervix (CL \u2264\u200925\u2009mm; base\u2010case) and for spontaneous PTD at <\u200933\u2009+\u20090\u2009weeks and at 33\u2009+\u20090 to 36\u2009+\u20096\u2009weeks were derived from the CERVIX study, and probabilities for stillbirth, neonatal mortality and long\u2010term morbidity (cerebral palsy) from Swedish health data registers. Costs were based on Swedish data, except costs for cerebral palsy, which were based on Danish data. We assumed that vaginal progesterone reduces spontaneous PTD before 33\u2009weeks by 30% and spontaneous PTD at 33\u201336\u2009weeks by 10% (based on the literature). All analyses were from a societal perspective. We expressed the effectiveness of each strategy as gained quality\u2010adjusted life years (QALYs) and presented cost\u2010effectiveness as average (ACER; average cost per gained QALY compared with \u2018No screening\u2019) and incremental (ICER; difference in costs divided by the difference in QALYs for each of two strategies being compared) cost\u2010effectiveness ratios. We performed deterministic and probabilistic sensitivity analysis. The results of the latter are shown as cost\u2010effectiveness acceptability curves. Willingness\u2010to\u2010pay was set at a maximum of 500\u2009000 Swedish krona (56\u2009000 US dollars (USD)), as suggested by the Swedish National Board of Health and Welfare.<\/jats:p><\/jats:sec>Results<\/jats:title>All interventions had better health outcomes than did \u2018No screening\u2019, with fewer screening\u2010year deaths and more lifetime QALYs. The best strategy in terms of improved health outcomes was \u2018Low\u2010risk\u2010based screening\u2019, irrespective of whether screening was performed at 18\u2009+\u20090 to 20\u2009+\u20096\u2009weeks (Cx1) or at 21\u2009+\u20090 to 23\u2009+\u20096\u2009weeks (Cx2). \u2018Low\u2010risk\u2010based screening\u2019 at Cx1 was cost\u2010effective, while \u2018Low\u2010risk\u2010based screening\u2019 at Cx2 entailed high costs compared with other alternatives. The ACERs were 2200 USD for \u2018Low\u2010risk\u2010based screening\u2019 at Cx1 and 36\u2009800 USD for \u2018Low\u2010risk\u2010based screening\u2019 at Cx2. Cost\u2010effectiveness was particularly sensitive to progesterone effectiveness and to productivity loss due to sick leave during pregnancy. The probability that \u2018Low\u2010risk\u2010based screening\u2019 at Cx1 is cost\u2010effective compared with \u2018No screening\u2019 was 71%.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Interventions to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy, including CL screening with progesterone treatment of cases with a short cervix, may be cost\u2010effective in Sweden. \u00a9 2022 The Authors. Ultrasound in Obstetrics & Gynecology<\/jats:italic> published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24884","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T12:04:33Z","timestamp":1645617873000},"page":"778-792","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Cost\u2010effectiveness of cervical length screening and progesterone treatment to prevent spontaneous preterm delivery in Sweden"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4208-8667","authenticated-orcid":false,"given":"T.","family":"Wikstr\u00f6m","sequence":"first","affiliation":[{"name":"Centre of Perinatal Medicine and Health, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg 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