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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources: 

Cost-effectiveness of first-trimester screening with early preventative use of aspirin in women at high risk of early-onset pre-eclampsia