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

Related ObG Topics:

Aspirin Treatment for Women at Risk for Preeclampsia – ACOG, SMFM 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?