First trimester screening for pre-eclampsia and targeted aspirin prophylaxis: a cost-effectiveness cohort study

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.

Keywords: Fetal Medicine Foundation; National Institute for Health and Care Excellence; aspirin; cost-effectiveness; first trimester combined screening; mean arterial blood pressure; pre-eclampsia; pregnancy associated plasma protein-A; preterm pre-eclampsia.