Is Aspirin for Early Preeclampsia Prophylaxis Cost-Effective?
BACKGROUND AND PURPOSE:
Current practice in Canada and US is to screen for preeclampsia based on clinical risk factors
Women at high risk are offered low-dose aspirin (75-162 mg/day in Canada; US recommendations 81 mg/day)
Ortved et al. (Ultrasound in Obstetrics & Gynecology, 2018) sought to determine whether using the ASPRE risk assessment approach with low-dose aspirin for prevention of early onset preeclampsia is cost effective
Decision tree analysis
Theoretical population based on 387,516 live births in Canada (over 1 year period)
Clinical and financial impact were simulated and modelled
Analysis based on
Fetal Medicine Foundation algorithm for prediction of early onset preeclampsia (see ‘Related ObG Topics’ below) in first trimester
Clinical factors, biomarkers and ultrasound
Aspirin started in high risk pregnancies <16 weeks
The probabilities and costs based on published literature and public databases
Theoretical population of 387,516 births per year
Screening and aspirin use: 705 cases of early preeclampsia
Current practice: 1801 cases
Estimated total cost (Canadian dollars)
Screening and aspirin use: $9.52 million
Current practice: $23.91 million
Annual cost saving to the Canadian healthcare system of approximately $14.39 million
Screening using clinical factors/biomarkers and ultrasound with aspirin prophylaxis for those at high risk to reduce early preeclampsia was found to be cost effective
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