(519) Cost-effectiveness of first trimester ultrasound for identifying congenital anomalies in states with 16-20-week abortion bans

Objective: Fetal anomalies contribute significantly to infant morbidity in the United States. In states with 16-20-week abortion bans, the standard practice of identifying fetal anomalies in the second trimester limits an individual’s pregnancy decision-making. This study aimed to evaluate the cost-effectiveness of a universal first-trimester ultrasound among pregnant individuals in the setting of abortion restrictions.

Study Design: A decision-analytic model was built using TreeAge software to evaluate the cost-effectiveness of first-trimester ultrasound in states with 16-20-week abortion bans. Our theoretical cohort included 1,500,000 individuals to represent the annual number of pregnancies in 19 states with bans to date. Fetal anomalies were categorized as lethal or major. Outcomes included abortion, stillbirth, maternal death, preeclampsia, and neonatal death. The cost-effectiveness threshold was set at $100,000/QALYs. Model inputs were derived from the literature, and sensitivity analyses were used to assess the robustness of the results.

Results: In our theoretical model, 3,960 lethal and 7,875 major anomalies were identified in the first trimester (Table 1). Relative to the standard second-trimester scan, the first-trimester ultrasound strategy was associated with 8,318 more first-trimester abortions, 1,970 fewer out-of-state second-trimester abortions, 266 fewer cases of preeclampsia, 831 fewer stillbirths, and 1,952 fewer neonatal deaths. First-trimester ultrasound led to 1,555 and 3,160 fewer live births with lethal and major anomalies, respectively. First-trimester ultrasound was the dominant strategy, with a 2.2 billion reduction in costs and an increase in 25,830 QALYs. The results were robust over a wide range of assumptions on sensitivity analyses.

Conclusion: Universal first-trimester ultrasound in states with abortion bans is cost-saving, resulting in improved neonatal outcomes, decreased healthcare costs, and improved quality of life. These findings may inform clinical practice and policies to improve individual and societal outcomes in the context of restricted healthcare access.