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

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