Abstract
Objective: Investigate cost effectiveness of first trimester
preeclampsia screening using the Fetal Medicine Foundation (FMF)
algorithm in comparison to standard care. Design: Retrospective
observational study Setting: London tertiary hospital Population: 5957
pregnancies screened for preeclampsia using the National Institute for
Health and Care Excellence (NICE) method. Methods: Differences in
pregnancy outcomes between those who developed preeclampsia, term
preeclampsia and preterm preeclampsia were compared by the
Kruskal-Wallis and Chi-square tests. The FMF algorithm was applied
retrospectively to the cohort. A decision analytic model was used to
estimate costs and outcomes for pregnancies screened using NICE and
those screened using the FMF algorithm. The decision point probabilities
were calculated using the included cohort. Main outcome measures:
Incremental healthcare costs and QALY gained per pregnancy screened.
Results: Of 5957 pregnancies, 12.8% and 15.9% were screen positive for
the development of preeclampsia using the NICE and FMF methods,
respectively. Of those screen positive by NICE recommendations, aspirin
was not prescribed in 25%. Across the three groups: pregnancies without
preeclampsia, term preeclampsia and preterm preeclampsia, respectively
there was a statistically significant trend in rates of emergency
caesarean (21%, 43%, 71.4%; p=<0.001), admission to
neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%;
p=<0.001) and length of stay in NICU. Use of the FMF algorithm
was associated with 7 fewer cases of preterm preeclampsia, cost saving
of £9.06 and a QALY gain of 0.00006/pregnancy screened. Conclusions: In
our cohort, using a conservative approach, application of the FMF
algorithm achieved clinical benefit and an economic cost saving.