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First trimester screening for preeclampsia: a cost-effectiveness cohort study
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  • Diane Nzelu,
  • Tom Palmer,
  • Daniel Stott,
  • Pranav Pandya,
  • Raffaele Napolitano,
  • Davide Casagrandi,
  • Christina Ammari,
  • Sara Hillman
Diane Nzelu
UCLH
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Tom Palmer
UCL
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Daniel Stott
UCLH
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Pranav Pandya
uclh
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Raffaele Napolitano
UCLH
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Davide Casagrandi
UCLH
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Christina Ammari
UCLH
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Sara Hillman
UCLH

Corresponding Author:[email protected]

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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.
24 Nov 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
30 Nov 2022Submission Checks Completed
30 Nov 2022Assigned to Editor
30 Nov 2022Review(s) Completed, Editorial Evaluation Pending
07 Dec 2022Reviewer(s) Assigned
13 Feb 2023Editorial Decision: Revise Major
16 Mar 20231st Revision Received
27 Mar 2023Submission Checks Completed
27 Mar 2023Assigned to Editor
27 Mar 2023Review(s) Completed, Editorial Evaluation Pending
22 May 2023Editorial Decision: Revise Minor
12 Jun 20232nd Revision Received
15 Jun 2023Submission Checks Completed
15 Jun 2023Assigned to Editor
15 Jun 2023Review(s) Completed, Editorial Evaluation Pending
20 Jun 2023Editorial Decision: Accept