Cost-effectiveness analysis of a first-trimester screening test for preterm preeclampsia in the Netherlands

• Published in: Journal of reproductive immunology 2023-12, Vol.160, p.104141, Article 104141
• Main Authors: Beernink, Rik H.J., Scherjon, Sicco A., Cremers, Thomas I.F.H., van Asselt, Antoinette D.I.
• Format: Article
• Language: English
• Subjects: Aspirin - therapeutic use; Cost-Effectiveness Analysis; Female; Humans; Infant, Newborn; Netherlands; Pre-Eclampsia - diagnosis; Pre-Eclampsia - prevention & control; Pregnancy; Pregnancy Trimester, First; Preterm preeclampsia
• ISSN: 0165-0378; 1872-7603; 1872-7603
• DOI: 10.1016/j.jri.2023.104141

The risk of preterm preeclampsia (PT PE) can significantly be reduced by starting acetylsalicylic acid ≤ 16 weeks of gestational age. First trimester predictive models based on maternal risk factors to effectively start this therapy lacked sufficient power, but recent studies showed that these models can be improved by including test results of biochemical and/or -physical markers. To investigate whether testing a biochemical marker in the first trimester is cost-effective in the Netherlands, a cost-effectiveness analysis was performed in this study. The outcome of this study was expressed as an incremental cost-effectiveness ratio (ICER) with as effect prevented PT PE cases. To evaluate the impact of each model parameter and to determine model uncertainties, both univariate and probabilistic sensitivity analyses were performed. When compared to the baseline strategy, the test strategy is estimated to save almost 4 million euros per year on a national scale and at the same time this would prevent an additional 228 PT PE cases. The sensitivity analyses showed that the major drivers of the result are the costs to monitor a high-risk pregnancy and the specificity and that most of the model simulations were in the southeast quadrant: cost saving and more prevented complications. This study showed that a first-trimester test strategy to screen for PT PE in the first trimester is potentially cost-effective in the Dutch healthcare setting. The fact that the specificity is a major driver of the ICER indicates the importance for a (new) screening model to correctly classify low-risk pregnancies. •This study is a cost-effective analysis of a screening test for preterm preeclampsia.•First-trimester screening for this disorder can be cost-effective in the Netherlands.•A test strategy is estimated to save almost €4.000.000 per year.•A test strategy would also prevent an additional 228 cases of preterm preeclampsia.