{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:44:31Z","timestamp":1790671471417,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this cost\u2010utility analysis was to model the clinical and economic impact of three cervical\u2010length screening strategies among low\u2010risk twin pregnancies: two\u2010step universal screening (at 18\u201320 and 20\u201322\u2009weeks), one\u2010step universal screening (at 18\u201320\u2009weeks) and no screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used a decision\u2010analytic model (decision tree and cohort state transition model) with a 100\u2010year time horizon in a Canadian context. The population included dichorionic diamniotic twin pregnancies without a history of preterm birth or prophylactic progesterone or cerclage. The model assumed that vaginal progesterone was initiated for cervical length \u2264\u200925\u2009mm and that cervical cerclage was performed plus vaginal progesterone treatment for cervical length \u2264\u200915mm. The primary outcomes were total lifetime health\u2010related costs (in 2023 Canadian dollars ($)), quality\u2010adjusted life years (QALYs) and incremental cost\u2010effectiveness ratios. Clinical outcomes included the probability of preterm birth (\u2264\u200928 and \u2264\u200934\u2009weeks), probability of stillbirth and life expectancy. Probabilistic and deterministic sensitivity analyses were carried out.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Base\u2010case and probabilistic sensitivity analysis showed that, when compared with no screening, the two\u2010step screening strategy increased the QALYs modestly (0.62 (95% credible interval (CrI), \u22120.16 to 1.41)) and decreased lifetime costs (\u2212$2460 (95%\u2009CrI, \u2212$4850 to $251)) by reducing the rate of preterm birth. The one\u2010step screening strategy, although inferior to the two\u2010step screening strategy, also increased the QALYs and reduced costs. Findings consistent with these were obtained on testing of the model assumptions with deterministic sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This cost\u2010utility analysis supports a universal two\u2010step screening strategy for twin pregnancies in a Canadian context. Although the conclusions of this analysis are robust in terms of the sensitivity analysis, more reliable predictions of long\u2010term costs and quality of life require more twin\u2010specific lifetime data. Additionally, cost\u2010utility analyses in other healthcare contexts are needed. \u00a9 2025 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.29287","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T07:54:38Z","timestamp":1752134078000},"page":"290-297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Universal cervical\u2010length screening to prevent preterm birth in twin pregnancy: cost\u2010utility analysis"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1850-2100","authenticated-orcid":false,"given":"Y.","family":"Khaikin","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Toronto  Toronto ON Canada"},{"name":"Institute of Health Policy, Management, and Evaluation University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6485-4879","authenticated-orcid":false,"given":"R. A.","family":"Gladstone","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Toronto  Toronto ON Canada"},{"name":"Institute of Health Policy, Management, and Evaluation University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7327-2600","authenticated-orcid":false,"given":"K. E.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Toronto  Toronto ON Canada"},{"name":"Division of Maternal Fetal Medicine Mount Sinai Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2704-1385","authenticated-orcid":false,"given":"N.","family":"Melamed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Toronto  Toronto ON Canada"},{"name":"Division of Maternal Fetal Medicine Sunnybrook Health Sciences Centre  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5090-7936","authenticated-orcid":false,"given":"P.","family":"Pechlivanoglou","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and Evaluation University of Toronto  Toronto ON Canada"},{"name":"Child Health Evaluative Sciences The Hospital for Sick Children  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.03.040"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070549"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.03.003"},{"key":"e_1_2_7_6_1","unstructured":"Live births by characteristics of mother and child and weeks of gestation. 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