{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T10:26:57Z","timestamp":1768904817647,"version":"3.49.0"},"reference-count":51,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Monochorionic twin gestations affected by Type\u2010II selective fetal growth restriction (sFGR) are at increased risk of intrauterine fetal demise, extreme preterm birth, severe neurodevelopmental impairment (NDI) and neonatal death of one or both twins. In the absence of a consensus on the optimal management strategy, we chose to evaluate which strategy was cost\u2010effective in the setting of Type\u2010II sFGR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A decision\u2010analytic model was used to compare expectant management (EM), bipolar cord occlusion (BCO), radiofrequency ablation (RFA) and fetoscopic laser photocoagulation (FLP) for a hypothetical cohort of 10\u2009000 people with a monochorionic diamniotic twin pregnancy affected by Type\u2010II sFGR. Probabilities and utilities were derived from the literature. Costs were derived from the Healthcare Cost and Utilization Project and adjusted to 2023 USD. The analytic horizon, taken from the perspective of the pregnant patient, extended throughout the life of the child or children. An incremental cost\u2010effectiveness ratio of 50\u2009000\u2009USD per quality\u2010adjusted life year defined the willingness\u2010to\u2010pay threshold. One\u2010way and probabilistic sensitivity analysis was also performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For base\u2010case estimates, RFA was the most cost\u2010effective strategy compared with all of the other interventions included, with an incremental cost\u2010effectiveness ratio of 14\u2009243\u2009USD per quality\u2010adjusted life year. One\u2010way sensitivity analysis demonstrated that the utilities assigned to fetal demise and severe NDI, as well as the costs of preterm birth before 32\u2009weeks, most strongly impacted the model outcomes. On probabilistic sensitivity analysis, RFA was the most cost\u2010effective strategy in 78% of runs, followed by BCO at 20%, EM at 2% and FLP in 0% of runs. When compared with EM, RFA led to 58 fewer births before 28\u2009weeks' gestation, 273 fewer cases of severe NDI and 22 more deliveries after 32\u2009weeks. When compared with FLP, RFA resulted in 259 fewer cases of severe NDI and 3177 more births after 32\u2009weeks. When compared with BCO, RFA resulted in 1786 more neurologically intact neonates and 34 fewer cases of severe NDI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>On base\u2010case analysis, RFA was found to be the most cost\u2010effective strategy in the management of monochorionic diamniotic twin pregnancies affected by Type\u2010II sFGR. However, these findings were not robust on sensitivity analysis, indicating the potential benefit of BCO and EM. In the absence of large clinical trials, these data should not be taken to guide management. Future studies should evaluate management strategies for Type\u2010II sFGR related to long\u2010term neonatal outcomes, inclusive of quality\u2010of\u2010life indicators, in a prospective multicenter cohort. \u00a9 2024 The Author(s). <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.29135","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T15:43:02Z","timestamp":1732722182000},"page":"39-46","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of monochorionic diamniotic twin gestation affected by Type\u2010<scp>II<\/scp> selective fetal growth restriction: cost\u2010effectiveness analysis"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9741-1866","authenticated-orcid":false,"given":"J. 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