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#Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Strategies for Prescribing Aspirin to Prevent Preeclampsia: A Cost-Effectiveness Analysis

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Related ObG Topics:

Aspirin Treatment for Women at Risk for Preeclampsia – ACOG and USPSTF Recommendations  
ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia
Results from the SPREE Trial: How Does First Trimester Preeclampsia Screening Compare to Current Guidelines?
Which Markers Can We Use to Screen for Early and Late Preeclampsia?

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