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First Trimester Screening for Preterm Preeclampsia in the United Kingdom: A Cost-Effectiveness Analysis
Mohammad A Ani1, Liona C Poon2,3, Laura A Magee4
1Roche Diagnostics UK and Ireland, Burgess Hill, UK.
Summary
The Fetal Medicine Foundation (FMF) strategy is more cost-effective for first-trimester preterm preeclampsia (PE) screening than the NICE strategy in the UK. It saves costs and improves quality-adjusted life years (QALYs).
Area of Science:
- Maternal-fetal medicine
- Health economics
- Screening technologies
Background:
- Preterm preeclampsia (PE) poses significant risks to maternal and fetal health.
- Current screening guidelines, such as those from the National Institute for Health and Care Excellence (NICE), aim to identify high-risk pregnancies early.
- The Fetal Medicine Foundation (FMF) offers an alternative screening strategy utilizing multiple biomarkers.
Purpose of the Study:
- To conduct a cost-effectiveness analysis comparing the FMF screening strategy with the NICE strategy for first-trimester preterm PE detection in the UK.
- To determine the economic implications and health outcomes associated with each screening approach.
Main Methods:
- A decision-tree model was employed for cost-effectiveness analysis from a UK National Health Service perspective.
- Simulated 10,000 singleton pregnancies at 11-13 weeks' gestation over a lifetime horizon.
- Compared NICE-recommended screening with FMF screening (maternal factors, mean arterial pressure, uterine artery pulsatility index, placental growth factor), with high-risk patients receiving aspirin.
Main Results:
- The FMF strategy demonstrated cost-savings of £3191 and a gain of 0.92 quality-adjusted life years (QALYs) per 10,000 patients compared to the NICE strategy.
- This resulted in a cost-saving of £199 per case of preterm PE avoided.
- Scenario analyses confirmed the FMF strategy's cost-effectiveness across various PE incidences and aspirin adherence rates.
Conclusions:
- The FMF strategy is a more cost-effective approach for first-trimester screening of preterm preeclampsia in the UK compared to the NICE strategy.
- The FMF strategy, incorporating maternal factors, MAP, UtA-PI, and PlGF, proved to be the most clinically effective option.
- This finding supports the adoption of the FMF strategy for improved resource allocation and patient outcomes in PE screening.
