@Article{chd.12713,
AUTHOR = {Patrick D. Evers, Tarek Alsaied, Jeffrey B. Anderson, James F. Cnota, Allison A. Divanovic},
TITLE = {Prenatal heart block screening in mothers with SSA/SSB autoantibodies: Targeted screening protocol is a cost‐effective strategy},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {2},
PAGES = {221--229},
URL = {http://www.techscience.com/schd/v14n2/38765},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> 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.<br/>
<b>Design:</b> 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.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusion:</b> 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.},
DOI = {10.1111/chd.12713}
}