Grand Rounds

Cost-Effectiveness of Adding Biomarkers and Ultrasound to Preeclampsia Screening Algorithms

BACKGROUND AND PURPOSE:

Mallampati et al. (Obstetrics & Gynecology, 2019) assessed the cost-effectiveness analysis of various preeclampsia screening approaches, including the latest biomarkers and ultrasound parameters

Cost-effectiveness analysis
4 strategies (initiated <16 weeks) to prevent preeclampsia (see ‘Related ObG Topics’ below for more strategy details)
- Strategy 1: no aspirin use
- Strategy 2: biomarker and ultrasound measure–predicated use
- Strategy 3: USPSTF guidelines (clinical risk factors – no biomarkers or ultrasound)
- Strategy 4: Universal aspirin use
Primary outcomes based on 100,000 pregnant women
- Preeclampsia-related costs
- Number of preeclampsia cases
Data analysis
- Assumes $90,843 per case of preeclampsia
- Probabilities analyses conducted to estimate risk reduction due to
  - Aspirin use
  - Aspirin-related side effects
  - Costs
- Identified ranges at which costs and risks of aspirin-related complications shifted the preferred strategy

Compared with universal aspirin administration
- USPSTF guideline is associated with
  - Increased healthcare costs | >$8,011,725
  - 346 additional cases of preeclampsia per 100,000 pregnant women
- Biomarker and ultrasound screening is also associated with
  - Increased healthcare costs | >$19,216,551
  - 308 additional cases of preeclampsia per 100,000 pregnant women
- No aspirin use is also associated with
  - Increased healthcare costs >$18,750,381
  - 762 additional cases of preeclampsia per 100,000 pregnant women
Based on statistical modeling, universal aspirin was the preferred strategy in 91% of simulations (of 10,000 pregnant women)
- USPSTF: Preferred in 8.5% of simulations
- Biomarker and ultrasound screening: Preferred in 0% of simulations
- No aspirin: Preferred in 0.5% of simulations

USPSTF guideline is associated with higher healthcare costs and more cases of preeclampsia
Universal aspirin use performed better than either of the three other strategies and was associated with lower healthcare costs and fewer cases of preeclampsia

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