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

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.