Model-Based Cost-Effectiveness Analysis of Routine Omega-3 Testing and Targeted Supplementation to Reduce Early Preterm Birth in Australia Compared with Current Practice

Background: Preterm birth remains a leading cause of newborn death, disability, and long-term health challenges globally, with a substantial impact on families, the health system, and society. Omega-3 supplementation in women with low omega-3 status in early pregnancy has been shown to reduce the risk of preterm birth, particularly early preterm birth (< 34 weeks of gestation). The cost implications of incorporating omega-3 testing and targeted supplementation into routine antenatal care to reduce early preterm birth in Australia are unclear. Methods: A decision analytic model was developed using Australian epidemiological, clinical, and cost data to compare routine omega-3 testing and targeted supplementation with current practice. The model predicted the number of early preterm births prevented and associated cost savings over an 18-year time horizon. Deterministic sensitivity analyses were conducted to examine uncertainty in key model inputs. Results: Among 289,195 singleton pregnancies in 2022, an estimated 17.5% of women would have low omega-3 status and be eligible for supplementation. Making conservative assumptions, the model predicted that, relative to current practice, omega-3 testing and supplementation would be a dominant strategy, preventing 640 early preterm births, with projected savings of $26.1 million in direct healthcare costs. Sensitivity analyses indicated that the results were robust across most scenarios and identified the treatment effect estimate as the strongest driver of model predictions. Conclusion: Omega-3 testing in early pregnancy with targeted supplementation may offer a scalable and cost-effective strategy to reduce early preterm birth with potential benefits for mothers, infants, and the health system. The modelling suggests meaningful health and economic benefits. Cost savings were robust across most plausible scenarios, supporting the potential value of this approach on a national scale. Plain Language Summary: Every year, thousands of babies in Australia are born too early, putting them at risk of serious health problems and placing a heavy burden on families and the health system. Babies born before 34 weeks of pregnancy face the greatest risks of death, intensive care, long hospital stays, and lifelong challenges. Evidence shows that omega-3 supplementation lowers the risk of preterm birth for women with low omega-3 levels, and this recommendation was included in Australia’s National Pregnancy Care Guidelines. We assessed whether introducing a simple omega-3 blood test and offering high-dose supplements to women with low levels, as part of routine pregnancy care, would be cost-effective. Using Australian data, we built a model to compare this approach with current care. Under conservative assumptions, the model predicted that testing and targeted supplementation could prevent about 640 births before 34 weeks of gestation each year and save $26 million in direct healthcare costs and $44.7 million overall. For every dollar invested, the health system could save $1.67 in direct costs and $3.00 in total costs. Adding omega-3 testing with targeted supplementation to routine pregnancy care has the potential to improve outcomes for mothers and babies while reducing healthcare costs substantially. This is an affordable, evidence-based change that could deliver significant benefits nationwide.