Cost-effectiveness of first-trimester screening with early preventative use of aspirin in women at high risk of early-onset pre-eclampsia.
OBJECTIVE
Pre-eclampsia (PE) remains a leading cause of maternal and fetal morbidity and mortality. A first-trimester screening algorithm predicting the risk of early-onset PE has been developed and validated. Early prediction coupled with initiation of aspirin at 11-13 weeks in women identified as high risk is effective at reducing the prevalence of early-onset PE. The aim of this study was to evaluate the cost-effectiveness of this first-trimester screening program coupled with early use of low-dose aspirin in women at high risk of developing early-onset PE, in comparison to current practice in Canada.


METHODS
A decision analysis was performed based on a theoretical population of 387 516 live births in Canada in 1 year. The clinical and financial impact of early preventative screening using the Fetal Medicine Foundation algorithm for prediction of early-onset PE coupled with early (< 16 weeks) use of low-dose aspirin in those at high risk was simulated and compared with current practice using decision-tree analysis. The probabilities at each decision point and associated costs of utilized resources were calculated based on published literature and public databases.


RESULTS
Of the theoretical 387 516 births per year, the estimated prevalence of early PE based on first-trimester screening and aspirin use was 705 vs 1801 cases based on the current practice. This was associated with an estimated total cost of C$9.52 million with the first-trimester screening program compared with C$23.91 million with current practice for the diagnosis and management of women with early-onset PE. This equals an annual cost saving to the Canadian healthcare system of approximately C$14.39 million.


CONCLUSIONS
The implementation of a first-trimester screening program for PE and early intervention with aspirin in women identified as high risk for early PE has the potential to prevent a significant number of early-onset PE cases with a substantial associated cost saving to the healthcare system in Canada. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
['Ortved|D|D|0000-0001-6572-6839', 'Hawkins|T L-A|TL|', 'Johnson|J-A|JA|0000-0001-6451-8210', 'Hyett|J|J|', 'Metcalfe|A|A|']
D000328:Adult D000465:Algorithms D001241:Aspirin D003362:Cost-Benefit Analysis D003663:Decision Trees D005260:Female D006801:Humans D008403:Mass Screening D010975:Platelet Aggregation Inhibitors D011225:Pre-Eclampsia D011247:Pregnancy D011261:Pregnancy Trimester, First D018566:Pregnancy, High-Risk D016216:Ultrasonography, Prenatal
cost-effectiveness first-trimester screening aspirin early-onset pre-eclampsia