Related Experiment Video
Updated: Dec 10, 2025
Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
Cost-effectiveness analysis of a model of first-trimester prediction and prevention of preterm pre-eclampsia compared
Insights
Implementing first-trimester screening and low-dose aspirin prophylaxis significantly reduces preterm pre-eclampsia (PE) cases and healthcare costs. This cost-effective strategy improves maternal and neonatal outcomes in public health settings.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Health Economics
Background:
- Pre-eclampsia (PE) poses significant risks to maternal and neonatal health, leading to mortality and morbidity.
- First-trimester prediction models combined with low-dose aspirin prophylaxis show promise in reducing PE prevalence.
- PE incurs substantial economic costs on society and healthcare systems.
Purpose of the Study:
- To evaluate the health outcomes and cost implications of first-trimester prediction and prevention of preterm PE in a public healthcare setting.
- To compare a screening and prophylaxis program with usual care for preterm PE.
- To conduct a cost-effectiveness analysis to guide health-service policy decisions.
Main Methods:
- A decision-analytic model compared usual care with a first-trimester screening intervention for 6822 obstetric patients.
- The model assessed risk assessment strategies and compliance with low-dose aspirin for PE prevention.
- Health outcomes ranged from no PE to maternal death, with economic costs analyzed over a 2-year period.
Main Results:
- The intervention resulted in 31 fewer cases of PE and reduced health-service costs by over 1.4 million Australian dollars.
- Sensitivity analyses confirmed no increase in PE cases or economic costs with the intervention.
- The first-trimester screening intervention demonstrated superior outcomes and cost-effectiveness compared to usual care.
Conclusions:
- A population-based program of first-trimester prediction and prevention of preterm PE is cost-effective.
- The strategy significantly reduces PE prevalence and generates substantial cost savings.
- Implementation of this policy is supported by the findings for public health services.
Objectives:
Pre-eclampsia (PE) causes substantial maternal and neonatal mortality and morbidity. In addition to the personal impact on women, children and their families, PE has a significant economic impact on our society. Recent research suggests that a first-trimester multivariate model is highly predictive of preterm (< 37 weeks' gestation) PE and can be combined successfully with targeted prophylaxis (low-dose aspirin), resulting in an 80% reduction in prevalence of disease. The aim of this study was to examine the potential health outcomes and cost implications following introduction of first-trimester prediction and prevention of preterm PE within a public healthcare setting, compared with usual care, and to conduct a cost-effectiveness analysis to inform health-service decisions regarding implementation of such a program.
Methods:
A decision-analytic model was used to compare usual care with the proposed first-trimester screening intervention within the obstetric population (n = 6822) attending two public hospitals within a metropolitan district health service in New South Wales, Australia, between January 2015 and December 2016. The model, applied from early pregnancy, included exposure to a variety of healthcare professionals and addressed type of risk assessment (usual care or first-trimester screening) and use of (compliance with) low-dose aspirin prescribed prophylactically for prevention of PE. All pathways culminated in six possible health outcomes, ranging from no PE to maternal death. Results were presented as the number of cases of PE gained/avoided and the incremental increase/decrease in economic costs arising from the intervention compared with usual care. Significant assumptions were tested in sensitivity/uncertainty analyses.
Results:
The intervention produced, across all gestational ages, 31 fewer cases of PE and reduced aggregate economic health-service costs by 1 431 186 Australian dollars over the 2-year period. None of the tested iterations of uncertainty analyses reported additional cases of PE or higher economic costs. The new intervention based on first-trimester screening dominated usual care.
Conclusion:
This cost-effectiveness analysis demonstrated a reduction in prevalence of preterm PE and substantial cost savings associated with a population-based program of first-trimester prediction and prevention of PE, and supports implementation of such a policy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Related Concept Videos
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:52Regression Toward the Mean
01:30Preventive Healthcare Services
01:20Study Designs in Epidemiology
Observational studies are those where the researcher does not intervene but rather observes natural variations. They include cross-sectional, cohort, and...