Fetus
Poster Session 2
Jamie Schlacter, BS
Medical Student
New York University Grossman School of Medicine
New York, NY, United States
Enrico Danzer, MD
Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College
New York, NY, United States
Claire H. Packer, MD, MPH (she/her/hers)
Resident
Brigham and Women's Hospital, Harvard Medical School
Boston, MA, United States
Eric Johnson, BA, MS
Stanford University
Stanford, CA, United States
Aaron B. Caughey, MD, PhD
Professor and Chair
Oregon Health & Science University
Portland, OR, United States
Yair J. Blumenfeld, MD
Professor
Stanford University
Palo Alto, CA, United States
Kunj Sheth, MD
Stanford University
Stanford, CA, United States
The Vortex shunt, a novel fetal vesico-amniotic shunt (VAS), has shown improved dislodgement characteristics compared to current shunts in in-vitro and pre-clinical studies. We aimed to evaluate the Vortex shunt’s potential cost-effectiveness compared to standard shunts.
Study Design:
We designed a decision-analytic model using TreeAge to compare outcomes and costs in fetuses undergoing VAS for fetal LUTO using the Vortex shunt compared to current shunts. We assumed a 50% dislodgement risk and 36% probability of end-stage renal disease (ESRD) for current shunts per published literature, and compared that to the Vortex shunt’s expected 10% dislodgement risk and 18% ESRD rate. We used a theoretical cohort of 1,000 neonates, the number of annual U.S. LUTO cases. Outcomes included ESRD, neurodevelopmental disability (NDD), neonatal death, direct/indirect costs, and quality-adjusted life years (QALYs). A societal perspective with a lifetime horizon was used to determine cost in 2022 U.S. dollars. Maternal and neonatal QALYs were considered and took into account a standard 3% discount rate. The incremental cost-effectiveness ratio (ICER) was determined with a $100,000/QALY willingness to pay threshold. Model inputs were derived from literature, and sensitivity analyses were conducted to assess robustness and account for data uncertainty.
Results:
Of 1,000 LUTO pregnancies, the Vortex shunt resulted in 60 fewer cases of ESRD and 10 fewer children with NDD. The Vortex shunt was the dominant strategy indicating lower costs and higher QALYs compared to available shunts. Estimated lifetime savings totaled $132,976 for each fetus undergoing VAS. There were no differences in neonatal death. Sensitivity analyses suggest the Vortex shunt is more cost effective across a wide range of model inputs and remains the dominant strategy when varying Vortex theoretical shunt dislodgement rate from 10% to 40%.
Conclusion:
Our model suggests the Vortex shunt may be significantly more cost effective compared to current shunts. The Vortex shunt’s actual dislodgement rate and renal outcomes must be validated in future studies.