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Published on: August 2, 2017
Cost-benefit analysis of first-trimester pre-eclampsia screening: comparison of multivariable Gaussian algorithm with
E Bonacina1,2, M Armengol-Alsina1,2,3, M Dalmau2,3
1Maternal and Fetal Medicine Research group. Vall d'Hebron Research Institute (VHIR), Centres de Recerca de Catalunya (CERCA), Barcelona, Spain.
Insights
Screening for pre-eclampsia (PE) using a Gaussian algorithm, with or without placental growth factor (PlGF), offers cost savings. While the algorithm alone saved more, adding PlGF improved PE prevention, making it a valuable strategy if PlGF costs are managed.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Health Economics
Background:
- Pre-eclampsia (PE) is a significant global cause of maternal and neonatal morbidity and mortality.
- Early identification in the first trimester enables preventive treatment with low-dose aspirin.
- Cost-benefit analysis of screening strategies is crucial for resource allocation in maternal healthcare.
Purpose of the Study:
- To evaluate the cost-benefit of multivariable Gaussian algorithm-based pre-eclampsia (PE) screening strategies.
- To compare screening with and without placental growth factor (PlGF) against no screening.
- To inform clinical implementation and adoption of PE screening protocols.
Main Methods:
- Cost-benefit analysis of two screening strategies (Gaussian algorithm with and without PlGF) versus no screening.
- Utilized real-world data from 56,344 pregnancies in Catalan maternity centers (2023).
- Included sensitivity and scenario analyses to identify cost drivers and thresholds.
Main Results:
- Both screening strategies demonstrated cost savings compared to no screening.
- Gaussian algorithm without PlGF yielded higher savings (€3.38 million) than with PlGF (€3.29 million).
- PlGF addition improved PE prevention; cost-benefit for PlGF strategy requires reagent cost ≤ €4.31.
Conclusions:
- Gaussian algorithm without PlGF showed maximum cost savings.
- Incorporating PlGF enhances PE prevention, supporting its broader clinical adoption.
- A PlGF reagent cost below €4.31 per unit is key for cost-beneficial implementation of the PlGF strategy.
Objective:
Pre-eclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality worldwide. Early identification of high-risk pregnancies in the first trimester allows preventive treatment with low-dose aspirin. This study aimed to evaluate whether multivariable Gaussian algorithm-based PE screening strategies, with and without placental growth factor (PlGF), are cost beneficial compared with no screening.
Methods:
The cost-benefit analysis estimated the total healthcare savings for the two screening strategies compared with no screening, considering both the costs associated with implementing the screening and the savings derived from the number of cases of PE and preterm infants prevented. The analysis was based on real-world data from Catalan maternity centers applied to a cohort of 56 344 pregnancies (annual birth rate in 2023). Univariable sensitivity and best- and worst-case scenario analyses were also conducted.
Results:
Both screening strategies resulted in cost savings compared with no screening. The Gaussian algorithm without PlGF yielded greater healthcare savings (€3.38 million) than did the Gaussian algorithm with PlGF (€3.29 million). However, the addition of PlGF provided greater clinical benefit, preventing a higher number of PE cases. Sensitivity analysis identified PE incidence and preterm birth rates as the primary cost drivers. For the PlGF strategy to be cost beneficial, the PlGF reagent cost per unit should not exceed €4.31.
Conclusions:
Although the Gaussian algorithm without PlGF demonstrated the highest cost savings compared with no screening, incorporating PlGF further improved PE prevention, supporting its broader adoption. A PlGF reagent cost per unit below €4.31 may make this strategy cost-beneficial, enhancing its clinical implementation. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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