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Which first-trimester risk assessment method for preeclampsia is most suitable? A model-based impact study.

Lynn T M Strijbos1, Manouk L E Hendrix2, Salwan Al-Nasiry3

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American Journal of Obstetrics & Gynecology MFM
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PubMed
Summary

Comparing first-trimester preeclampsia risk assessment models, the EXPECT and Fetal Medicine Foundation methods effectively reduce preeclampsia incidence. The EXPECT model offers the highest cost savings, though it involves treating more women with low-dose aspirin.

Keywords:
EXPECTFetal Medicine FoundationNational Institute for Health and Care Excellenceadherenceaspirinhealthcare costspreeclampsiapregnanciesprevalencerisk assessments

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Health Economics

Background:

  • Low-dose aspirin is proven to reduce preeclampsia risk in high-risk pregnancies.
  • Several first-trimester risk assessment methods are used internationally.

Purpose of the Study:

  • To compare the cost-effectiveness of three first-trimester preeclampsia risk estimation algorithms: EXPECT, National Institute for Health and Care Excellence (NICE), and Fetal Medicine Foundation (FMF).
  • To evaluate these algorithms when used in conjunction with low-dose aspirin treatment versus no risk assessment.

Main Methods:

  • A decision-analytical model was developed to estimate preeclampsia cases and costs for each strategy.
  • A hypothetical population of 100,000 women was used for analysis.
  • One-way sensitivity analyses were conducted to assess the impact of adherence rates.

Main Results:

  • Preeclampsia incidence was 1.98% (EXPECT), 2.55% (NICE), 1.90% (FMF), and 3.00% (no assessment).
  • Net financial benefits per patient were €144 (EXPECT), €43 (NICE), and €38 (FMF) compared to no assessment.
  • Aspirin treatment rates were 18.6% (EXPECT), 10.2% (NICE), and 6.0% (FMF).

Conclusions:

  • The EXPECT and FMF models are superior to NICE and no assessment in preventing preeclampsia.
  • EXPECT is the most cost-effective, despite requiring higher aspirin treatment rates.
  • The choice of strategy involves balancing cost savings and ease of use against potential overtreatment, considering low-dose aspirin's safety profile.