An economic analysis of prenatal fetoscopic versus open neural tube defect repair.

OBJECTIVE: Fetal repair of an open neural tube defect by hysterotomy has been shown to reduce the need for shunting and improve motor outcomes for infants, but increases the risk of cesarean section and prematurity. Fetoscopic repair is an alternate approach that may confer similar neurological benefits, but allows for vaginal delivery and reduces the incidence of hysterotomy related complications. We sought to compare the cost of the two approaches, from fetal surgery until neonatal discharge. METHODS: Retrospective cohort study of patients who underwent prenatal repair for open neural tube defects at a single institution from 2012 to 2018. Clinical outcomes were collected by chart review. A cost consequence analysis was conducted from the hospital perspective, and included hospital and physician costs for mothers and their infants. Costs were estimated using cost-to-charge ratios for hospital billing and the Physician Fee Schedule for physician billing. RESULTS: Seventy-eight patients were included (fetoscopic n = 47, open n = 31). Fewer women in the fetoscopic group underwent cesarean section (51% vs 100%, p< 0.001), and a more advanced average gestational age at birth was observed in the fetoscopic group (median 38.1, IQR 35.2 - 39.1 vs. median 35.7, IQR 33.9 - 37.0 weeks, p< 0.001). After adjusting for baseline characteristics, there was no significant difference in total cost between groups ($76,978, IQR $60,312 - $115,386 vs. $65,103, IQR $57,758 - $108,103, p=0.458). CONCLUSION: Fetoscopic repair of open neural tube defects, when compared to an open approach, reduces the incidence of cesarean section and preterm delivery with no significant difference in total costs of care from surgery to infant discharge. This novel approach may represent a cost-effective alternative to improve maternal and neonatal outcomes for this high-risk population. This article is protected by copyright. All rights reserved.