Background: Pre-eclampsia (PE) affects approximately 2-4% of pregnancies. Diagnosis involves repeated assessment of pregnant patients with risk factors. The sFlt-1/PlGF ratio test is shown to have clinical utility in ruling in and out PE among at-risk patients. By excluding the probability of PE, the addition of the sFlt-1/PlGF ratio test to antenatal care, may prevent unnecessary hospital admissions, intensive management, and premature delivery, thus reducing costs. Objectives: A systematic review to determine the cost-effectiveness of the sFlt-1/PlGF ratio test globally for pregnant patients at-risk of developing PE. Search Strategy: PubMed, Medline (OVID), National Health Service Economic Evaluation Database, Web of Science, Econlit, and Cost Effectiveness Analysis Registry searched between 2013-April 2023. Selection Criteria: Empirical studies quantifying costs of the sFlt-1/PlGF ratio test compared to other treatment options for patients with suspected PE. Data collection and Analysis: Eleven studies were included; all were cost analyses and modelled economic evaluations, and most used a health system perspective. Cost data were extracted and indexed to 2022 United States Dollars (USD). Main results: All studies reported “cost-savings” of the test in antenatal care. Studies varied with costs and assumptions included, therefore a large range of incremental cost savings per patient was reported ($15-$1,881, 2022USD). No Incremental Cost-Effectiveness Ratios or health outcomes including Quality Adjusted Life Years were reported. Conclusions: The included studies demonstrated “cost-savings” of the sFlt-1/PlGF ratio test in antenatal care for at-risk pregnant patients. However, this does not account for health outcome differences and long-term health care utilisation and expenditure. Funding: Nil

Debate: The placenta is the villain or victim in the pathogenesis of preeclampsia.

Objectives: To reach consensus on evidence-based recommendations to develop HDP management pathways for Indonesian primary care. Design: A three-round Delphi survey Setting: N/A Population: Maternal health practitioners and experts, including GPs, midwives, nurses and health policy researchers from Indonesia and international background. Methods: Participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP managements extracted from international guidelines were feasible in Indonesian primary care settings in a mix of quantitative and qualitative questions in three-rounds Delphi survey. A minimum of 70% agreement among participants was needed for a statement to be included for the HDP pathways that the pathways drafts were presented at the third-round survey. The participants’ free text questions responses and suggestions were analysed thematically. Main Outcome Measures: Agreement scores of the statements. Results: A total of 52 participants participated, 48, 45, and 37 of them completed the first, second and third-round survey respectively. The consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. The agreement scores ranged from 70.8-100.0% and potential implementation barriers were also identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions: Most evidence-based HDP management recommendations achieved consensus represented in the developed HDP management pathways can be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the pathways in practice.