Economic assessment of screening for pre-eclampsia

Authors


  • AS developed the model and the overall analysis. The database, clinical definitions and medical relevancies were contributed by RG. HM contributed to cost information and partial analysis. All authors participated in writing the manuscript and final analysis.
  • Funding sources: This study was funded in part by the European Union FP6 grant Pregenesys #037244 (HM) and the Canada-Israel industrial R&D Fund (CIIRDF) # 39 (HM)
  • Conflicts of interest: None declared

Hamutal Meiri.

E-mail: hamutal62@hotmail.com

ABSTRACT

Background

Pre-eclampsia is a major contributor to maternal and neonatal morbidity and mortality. Our objectives in this study are to economically assess, from the payer perspective, routine screening for pre-eclampsia using placental markers -placental protein 13 and placental growth factor - and uterine artery Doppler compared with standard care.

Methods

A decision model was developed, which progresses through three sequential endpoints, and compares screening with no screening: (1) Pre-eclampsia yes/no: calculation of the incremental cost of pre-eclampsia-case averted; (2) Hospital discharge: calculation of the mean accumulated costs until discharge after delivery; and (3) Offspring death: calculation of the incremental cost per quality of life-adjusted life-year gained by screening. Data used includes: (1) Obstetrical data of 14 500 births; (2) cost data from the Israeli Ministry of Health and the literature; and (3) screening performance and outcome from the literature.

Results

(1) The incremental cost of pre-eclampsia-case averted is $66 949 and $24 723 when the prevalence is 1.7 and 5% respectively. (2) With test cost of $112, the total cost until discharge with/without screening is equal. With pre-eclampsia prevalence of 3%, screening is cheaper. (3) The cost per quality of life-adjusted life-year with screening is $18 919 and < $10 000 with pre-eclampsia prevalence of 1.7 and 3%, respectively.

Conclusions

Screening for pre-eclampsia is cost-effective under various scenarios. © 2012 John Wiley & Sons, Ltd.

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