{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T02:05:28Z","timestamp":1771293928439,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Fetal endoscopic tracheal occlusion (FETO) improves neonatal survival of fetuses with congenital diaphragmatic hernia (CDH). However, FETO also increases the risk of preterm prelabor rupture of membranes (PPROM) and preterm delivery (PTD), as fetal membrane defects after fetoscopy do not heal. To solve this issue, an advanced sealing plug for closing the membrane defect is being developed. Using early\u2010stage health economic modeling, we aimed to estimate the potential value of this innovative plug in terms of costs and effects, and to determine the properties required for it to become cost\u2010effective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Early\u2010stage health economic modeling was applied to the case of performing FETO in women with a singleton pregnancy whose fetus is diagnosed prenatally with CDH. We simulated a cohort of patients using a state\u2010transition model over a 45\u2010year time horizon. In our best\u2010case\u2010scenario analysis, we compared the current\u2010care strategy with the perfect\u2010plug strategy, which reduces the risk of PPROM and PTD by 100%, to determine the maximum quality\u2010adjusted life years (QALYs) gained and costs saved. Using threshold analysis, we determined the minimum percentage reduction in the risk of PPROM and PTD required for the plug to be considered cost\u2010effective. The impact of model parameters on outcome was investigated using a sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our model indicated that a perfect\u2010plug strategy would yield on average an additional 1.94\u2009QALYs at a cost decrease of \u20ac2554 per patient. These values were influenced strongly by the percentage of cases with early PTD (27\u201334\u2009weeks). Threshold analysis showed that, for \u20ac500 per plug, the plug strategy needs a minimum percentage reduction of 1.83% in the risk of PPROM and PTD (i.e. reduction in the risk from 47.50% to 46.63% for PPROM and from 71.50% to 70.19% for\u00a0PTD) to be cost\u2010effective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our model\u2010based approach showed clear potential of the plug strategy when applied in the context of FETO for CDH fetuses, as only a minor reduction in the risk of PPROM and PTD is needed for the plug to be cost\u2010effective. Its value is expected to be even higher when used in conditions associated with a higher rate of early PTD. Continued investment in research and development of the plug strategy appears to provide value for money. \u00a9 2023 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26163","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T07:53:50Z","timestamp":1673942030000},"page":"710-718","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Plugging membranes after fetoscopy in congenital diaphragmatic hernia: early cost\u2010effectiveness analysis"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9088-5014","authenticated-orcid":false,"given":"J.","family":"Janssen","sequence":"first","affiliation":[{"name":"Department for Health Evidence Radboud University Medical Center, Radboud Institute for Health Sciences  Nijmegen The\u00a0Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"van Drongelen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Radboud University Medical Center, Radboud Institute for Health Sciences  Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3155-3030","authenticated-orcid":false,"given":"W. F.","family":"Daamen","sequence":"additional","affiliation":[{"name":"Department of Biochemistry Radboud University Medical Center, Radboud Institute for Molecular Life\u00a0Sciences  Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. P. 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