ABSTRACT
Objective: Investigate cost effectiveness of first trimester
preeclampsia screening using the Fetal Medicine Foundation (FMF)
algorithm in comparison to standard care.
Design: Retrospective observational study
Setting: London tertiary hospital
Population: 5957 pregnancies screened for preeclampsia using
the National Institute for Health and Care Excellence (NICE) method.
Methods: Differences in pregnancy outcomes between those who
developed preeclampsia, term preeclampsia and preterm preeclampsia were
compared by the Kruskal-Wallis and Chi-square tests. The FMF
algorithm was applied retrospectively to the cohort. A decision analytic
model was used to estimate costs and outcomes for pregnancies screened
using NICE and those screened using the FMF algorithm. The decision
point probabilities were calculated using the included cohort.
Main outcome measures: Incremental healthcare costs and QALY
gained per pregnancy screened.
Results: Of 5957 pregnancies, 12.8% and 15.9% were screen
positive for the development of preeclampsia using the NICE and FMF
methods, respectively. Of those screen positive by NICE recommendations,
aspirin was not prescribed in 25%. Across the three groups: pregnancies
without preeclampsia, term preeclampsia and preterm preeclampsia,
respectively there was a statistically significant trend in rates of
emergency caesarean (21%, 43%, 71.4%; p=<0.001), admission
to neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%;
p=<0.001) and length of stay in NICU. Use of the FMF algorithm
was associated with 7 fewer cases of preterm preeclampsia, cost saving
of £9.06 and a QALY gain of 0.00006/pregnancy screened.
Conclusions: In our cohort, using a conservative approach,
application of the FMF algorithm achieved clinical benefit and an
economic cost saving.
Funding: No funding was received for this study.
Keywords: preeclampsia, preterm preeclampsia, first trimester
combined screening, pregnancy associated plasma protein-A, PAPP-A,
National Institute for Health and Care Excellence, NICE,
cost-effectiveness, mean arterial blood pressure, Fetal Medicine
Foundation, aspirin.