Nzelu, Diane;
Palmer, Tom;
Stott, Daniel;
Pandya, Pranav;
Napolitano, Raffaele;
Casagrandi, Davide;
Ammari, Christina;
(2023)
First trimester screening for pre-eclampsia and targeted aspirin prophylaxis: a cost-effectiveness cohort study.
BJOG: An International Journal of Obstetrics and Gynaecology
10.1111/1471-0528.17598.
(In press).
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Abstract
Objective: Investigate cost-effectiveness of first trimester pre-eclampsia screening using the Fetal Medicine Foundation (FMF) algorithm and targeted aspirin prophylaxis in comparison with standard care. // Design: Retrospective observational study. // Setting: London tertiary hospital. // Population: 5957 pregnancies screened for pre-eclampsia using the National Institute for Health and Care Excellence (NICE) method. // Methods: Differences in pregnancy outcomes between those who developed pre-eclampsia, term pre-eclampsia and preterm pre-eclampsia were compared by the Kruskal–Wallis and Chi-square tests. The FMF algorithm was applied retrospectively to the cohort. A decision analytic model was used to estimate costs and outcomes for pregnancies screened using NICE and those screened using the FMF algorithm. The decision point probabilities were calculated using the included cohort. // Main outcome measures: Incremental healthcare costs and QALY gained per pregnancy screened. // Results: Of 5957 pregnancies, 12.8% and 15.9% were screen-positive for development of pre-eclampsia using the NICE and FMF methods, respectively. Of those who were screen-positive by NICE recommendations, aspirin was not prescribed in 25%. Across the three groups, namely, pregnancies without pre-eclampsia, term pre-eclampsia and preterm pre-eclampsia there was a statistically significant trend in rates of emergency caesarean (respectively 21%, 43% and 71.4%; P < 0.001), admission to neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%; P < 0.001) and length of stay in NICU. The FMF algorithm was associated with seven fewer cases of preterm pre-eclampsia, cost saving of £9.06 and QALY gain of 0.00006/pregnancy screened. // Conclusions: Using a conservative approach, application of the FMF algorithm achieved clinical benefit and an economic cost saving.
| Type: | Article |
|---|---|
| Title: | First trimester screening for pre-eclampsia and targeted aspirin prophylaxis: a cost-effectiveness cohort study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/1471-0528.17598 |
| Publisher version: | https://doi.org/10.1111/1471-0528.17598 |
| Language: | English |
| Additional information: | © 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Aspirin, cost-effectiveness, Fetal Medicine Foundation, first trimester combined screening, mean arterial blood pressure, National Institute for Health and Care Excellence, pre-eclampsia, pregnancy associated plasma protein-A, preterm pre-eclampsia |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10173330 |
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