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Prenatal heart block screening in mothers with SSA/SSB autoantibodies: Targeted screening protocol is a cost‐effective strategy

Patrick D. Evers1,*, Tarek Alsaied1,2,*, Jeffrey B. Anderson1, James F. Cnota1, Allison A. Divanovic1

1 Children’s Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2 Boston Children’s Hospital Heart Center, Boston, Massachusetts

* Corresponding Author: Allison A. Divanovic, MD, Pediatrics, Fetal Heart Program, Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 (allison.divanovic@ cchmc.org).

Congenital Heart Disease 2019, 14(2), 221-229. https://doi.org/10.1111/chd.12713

Abstract

Objective: Maternal anti-Ro/SSA and anti-La/SSB antibodies can lead to fetal complete heart block (CHB). Current guidelines recommend weekly echocardiographic screening between 16 and 28 weeks gestation. Given the cost of screening and the rarity of conduction abnormalities in fetuses of mothers with low anti-Ro levels (<50 U/mL), we sought to identify a strategy that optimizes resource utilization.
Design: Decision analysis cost-utility modeling was performed for three screening paradigms: “standard screening” (SS) in which mid-gestation mothers are screened weekly, “limited screening” (LS) in which fetal echocardiograms are avoided unless the fetus develops bradycardia, and “targeted screening by maternal antibody level” (TS) in which only high anti-Ro values warrant weekly screening. A systematic review of existing literature and institutional cost data were used to define model inputs.
Results: The average cost of LS, TS, and SS was $8566, $11 038, and $23 279, respectively. SS was cost-ineffective with an incremental cost-effectiveness ratio (ICER) of $322 756 while TS was cost-effective with an ICER of $43 445.
Conclusion: While the efficacy of fetal intervention for first or second degree AV block remains unclear, this analysis supports utilizing antibody levels to stratify this population for optimized surveillance for CHB. SS is cost-ineffective and results in resource overutilization.

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APA Style
Evers, P.D., Alsaied, T., Anderson, J.B., Cnota, J.F., Divanovic, A.A. (2019). Prenatal heart block screening in mothers with SSA/SSB autoantibodies: targeted screening protocol is a cost‐effective strategy. Congenital Heart Disease, 14(2), 221-229. https://doi.org/10.1111/chd.12713
Vancouver Style
Evers PD, Alsaied T, Anderson JB, Cnota JF, Divanovic AA. Prenatal heart block screening in mothers with SSA/SSB autoantibodies: targeted screening protocol is a cost‐effective strategy. Congeni Heart Dis. 2019;14(2):221-229 https://doi.org/10.1111/chd.12713
IEEE Style
P.D. Evers, T. Alsaied, J.B. Anderson, J.F. Cnota, and A.A. Divanovic "Prenatal heart block screening in mothers with SSA/SSB autoantibodies: Targeted screening protocol is a cost‐effective strategy," Congeni. Heart Dis., vol. 14, no. 2, pp. 221-229. 2019. https://doi.org/10.1111/chd.12713



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