Introduction
Preeclampsia (PE) affects 2% of pregnancies and carries significant
risks of maternal and perinatal morbidity and mortality, particularly
when occurring preterm.1 As a result, pregnancies
complicated by PE generate higher maternity costs.
Preterm PE is associated with a greater likelihood of admission to the
neonatal intensive care unit (NICU) and need for caesarean delivery.
These costly interventions are the primary drivers of the excess
economic burden arising with PE.2 Therefore,
strategies implemented to reduce the prevalence of preterm PE would not
only have considerable health benefits but also deliver cost-savings to
the healthcare system.
One such proven intervention is the use of aspirin. When given at a
daily dose of 150mg prior to 16 weeks’ gestation to women who are at
high risk of PE as determined by a combination of maternal
characteristics and biomarkers, aspirin reduces the risk of preterm PE
and admission to NICU by 62% and 66%, respectively.3,
4
Currently, in the United Kingdom (UK), the National Institute for Health
and Care Excellence (NICE) recommends identifying women who would
benefit from aspirin using maternal characteristics
alone.5 There are limitations to this method. First,
compliance is low with only 23% of women at high risk for PE being
prescribed aspirin from the first trimester.6 Second,
the performance of the NICE method in the prediction of preterm PE is
poor with a detection rate (DR) of 40.8%.6 This
combination of low compliance and poor sensitivity in identifying truly
high-risk pregnancies likely accounts for the more modest reductions in
PE with aspirin observed in earlier studies.7
The Fetal Medicine Foundation (FMF) algorithm for first trimester
prediction of PE combines maternal characteristics with biomarkers that
include placental growth factor (PLGF) or pregnancy associated plasma
protein-A (PAPP-A).6, 8 The DR for preterm PE using
the FMF algorithm has been demonstrated to be 69%. With the addition of
first trimester uterine artery pulsatility index (UtA-PI) Doppler, the
DR increases to 75%.8 Increased physician compliance
in aspirin prescribing and reduction in the prevalence of preterm PE and
delivery of SGA infants have been reported with implementation of the
FMF method.9-11 However, concerns around the increased
costs incurred by the package of care associated with the FMF method,
which includes routine third trimester ultrasound, have limited its
wider implementation.
Our objective was to investigate the cost effectiveness of first
trimester PE screening using the FMF algorithm in comparison to current
standard care recommended by NICE.