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First trimester screening for pre-eclampsia and targeted aspirin prophylaxis: a cost-effectiveness cohort study

Diane Nzelu1, Tom Palmer2, Daniel Stott1

  • 1Fetal Medicine Unit, University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health, London, UK.

BJOG : an International Journal of Obstetrics and Gynaecology
|July 11, 2023
PubMed

Insights

The Fetal Medicine Foundation (FMF) algorithm for first trimester pre-eclampsia screening is more cost-effective than standard care. This method reduces preterm pre-eclampsia cases, saving costs and improving quality-adjusted life years (QALYs).

Area of Science:

  • Maternal-fetal medicine
  • Health economics
  • Clinical screening algorithms

Background:

  • Pre-eclampsia poses significant risks to maternal and fetal health.
  • Current screening methods, like the NICE guideline, may not be optimally effective.
  • Early and accurate screening is crucial for timely intervention and improved outcomes.

Purpose of the Study:

  • To evaluate the cost-effectiveness of the Fetal Medicine Foundation (FMF) algorithm for first-trimester pre-eclampsia screening.
  • To compare the FMF algorithm with standard care (NICE method) in terms of clinical outcomes and economic impact.
  • To assess the role of targeted aspirin prophylaxis in conjunction with screening.

Main Methods:

  • A retrospective observational study involving 5957 pregnancies at a London tertiary hospital.
  • Comparison of pregnancy outcomes (pre-eclampsia, term pre-eclampsia, preterm pre-eclampsia) using Kruskal-Wallis and Chi-square tests.
  • Retrospective application of the FMF algorithm and a decision analytic model to estimate costs and QALYs gained per pregnancy screened.

Main Results:

  • The FMF algorithm identified 15.9% screen-positive cases, compared to 12.8% with the NICE method.
  • Aspirin was not prescribed in 25% of NICE screen-positive cases.
  • The FMF algorithm was associated with 7 fewer cases of preterm pre-eclampsia, a cost saving of £9.06, and a QALY gain of 0.00006 per pregnancy screened.

Conclusions:

  • The Fetal Medicine Foundation (FMF) algorithm demonstrates clinical benefit and economic cost savings in first-trimester pre-eclampsia screening.
  • Application of the FMF algorithm leads to a reduction in preterm pre-eclampsia.
  • This screening approach offers a more cost-effective strategy compared to standard care.
Abstract

Keywords:
Fetal Medicine FoundationNational Institute for Health and Care Excellenceaspirincost-effectivenessfirst trimester combined screeningmean arterial blood pressurepre-eclampsiapregnancy associated plasma protein-Apreterm pre-eclampsia

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