Introduction
Preeclampsia (PE) affects 2% of pregnancies and carries significant risks of maternal and perinatal morbidity and mortality, particularly when occurring preterm.1 As a result, pregnancies complicated by PE generate higher maternity costs.
Preterm PE is associated with a greater likelihood of admission to the neonatal intensive care unit (NICU) and need for caesarean delivery. These costly interventions are the primary drivers of the excess economic burden arising with PE.2 Therefore, strategies implemented to reduce the prevalence of preterm PE would not only have considerable health benefits but also deliver cost-savings to the healthcare system.
One such proven intervention is the use of aspirin. When given at a daily dose of 150mg prior to 16 weeks’ gestation to women who are at high risk of PE as determined by a combination of maternal characteristics and biomarkers, aspirin reduces the risk of preterm PE and admission to NICU by 62% and 66%, respectively.3, 4
Currently, in the United Kingdom (UK), the National Institute for Health and Care Excellence (NICE) recommends identifying women who would benefit from aspirin using maternal characteristics alone.5 There are limitations to this method. First, compliance is low with only 23% of women at high risk for PE being prescribed aspirin from the first trimester.6 Second, the performance of the NICE method in the prediction of preterm PE is poor with a detection rate (DR) of 40.8%.6 This combination of low compliance and poor sensitivity in identifying truly high-risk pregnancies likely accounts for the more modest reductions in PE with aspirin observed in earlier studies.7
The Fetal Medicine Foundation (FMF) algorithm for first trimester prediction of PE combines maternal characteristics with biomarkers that include placental growth factor (PLGF) or pregnancy associated plasma protein-A (PAPP-A).6, 8 The DR for preterm PE using the FMF algorithm has been demonstrated to be 69%. With the addition of first trimester uterine artery pulsatility index (UtA-PI) Doppler, the DR increases to 75%.8 Increased physician compliance in aspirin prescribing and reduction in the prevalence of preterm PE and delivery of SGA infants have been reported with implementation of the FMF method.9-11 However, concerns around the increased costs incurred by the package of care associated with the FMF method, which includes routine third trimester ultrasound, have limited its wider implementation.
Our objective was to investigate the cost effectiveness of first trimester PE screening using the FMF algorithm in comparison to current standard care recommended by NICE.