Cost-Effectiveness of Fetal Fibronectin Testing in Women at Risk for Preterm Birth: A Retrospective Cohort Study.

INTRODUCTION: The fetal fibronectin (fFN) test is used to predict true preterm delivery. This study aims to evaluate the cost-effectiveness of fFN testing versus no-fFN testing in identifying true preterm labor among women with preterm labor symptoms at risk for premature birth. METHODS: This retrospective cohort-based study was conducted among women who presented with symptoms of preterm labor between 24 and 34 weeks of gestation at a tertiary care hospital in Qatar and compared outcomes between those who received fetal fibronectin (fFN) testing and those who did not. A decision-tree model compared fFN testing to no testing, with the primary outcome being the incremental cost-effectiveness ratio, representing the additional cost for a successful delivery within 48 hours of admission. Clinical data were collected from HMC medical records, and direct medical costs was locally obtained, reflecting the Qatari hospital perspective. Sensitivity analyses confirmed the study results. RESULTS: A total of 519 women were analyzed. Significant baseline differences were observed between groups. The proportion of delivery within 48 hours was higher in the fFN group (94% vs 80%, P<0.0001). fFN testing was associated with a cost saving of QAR6,470 (US$1,777) per successful delivery. CONCLUSION: fFN testing was associated with better short-term clinical outcomes and lower healthcare costs. Nonetheless, due to the retrospective observational nature of the study and differences in baseline characteristics between groups, these results should be interpreted cautiously.