BJOG : an international journal of obstetrics and gynaecology · 2026
First Trimester Screening for Preterm Preeclampsia in the United Kingdom: A Cost-Effectiveness Analysis.
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Ani Mohammad A, Poon Liona C, Magee Laura A, Allen A Joy, Nicolaides Kypros H
Аннотация
OBJECTIVE: To evaluate the cost-effectiveness of the Fetal Medicine Foundation (FMF) strategy, compared with the National Institute for Health and Care Excellence (NICE) strategy, for first-trimester screening for preterm preeclampsia (PE) in the United Kingdom (UK).
DESIGN: Cost-effectiveness analysis.
SETTING: UK National Health Service and personal social services perspective.
POPULATION: A total of 10 000 simulated patients with singleton pregnancies at 11-13 weeks' gestation, across a lifetime time horizon.
METHODS: A decision-tree model was developed to perform a cost-effectiveness analysis. In the base-case analysis, NICE-recommended screening was compared with FMF screening, using maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF). The model assumed that patients identified as high-risk for PE were prescribed 150 mg aspirin daily until 36 weeks' gestation. Scenario analyses varied PE incidence, aspirin adherence and biomarker combinations of FMF strategy components.
MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratios (ICERs) were calculated using incremental costs and quality-adjusted life years (QALYs). Dominant ICERs demonstrated lower costs and higher QALYs.
RESULTS: Compared with NICE-recommended screening, the FMF strategy demonstrated a cost-saving of £3191 and QALY gain of 0.92 per 10 000 patients (dominant ICER), with a cost-saving of £199 per preterm PE case avoided. In scenario analyses, the FMF strategy was cost-effective across 3%, 5% and 7% PE incidence, and 75% and 100% aspirin adherence. The base-case FMF strategy (maternal factors + MAP + UtA-PI + PlGF) was the most clinically effective option.
CONCLUSIONS: The FMF strategy was more cost-effective versus the NICE strategy for first-trimester preterm PE screening in the UK.
DESIGN: Cost-effectiveness analysis.
SETTING: UK National Health Service and personal social services perspective.
POPULATION: A total of 10 000 simulated patients with singleton pregnancies at 11-13 weeks' gestation, across a lifetime time horizon.
METHODS: A decision-tree model was developed to perform a cost-effectiveness analysis. In the base-case analysis, NICE-recommended screening was compared with FMF screening, using maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF). The model assumed that patients identified as high-risk for PE were prescribed 150 mg aspirin daily until 36 weeks' gestation. Scenario analyses varied PE incidence, aspirin adherence and biomarker combinations of FMF strategy components.
MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratios (ICERs) were calculated using incremental costs and quality-adjusted life years (QALYs). Dominant ICERs demonstrated lower costs and higher QALYs.
RESULTS: Compared with NICE-recommended screening, the FMF strategy demonstrated a cost-saving of £3191 and QALY gain of 0.92 per 10 000 patients (dominant ICER), with a cost-saving of £199 per preterm PE case avoided. In scenario analyses, the FMF strategy was cost-effective across 3%, 5% and 7% PE incidence, and 75% and 100% aspirin adherence. The base-case FMF strategy (maternal factors + MAP + UtA-PI + PlGF) was the most clinically effective option.
CONCLUSIONS: The FMF strategy was more cost-effective versus the NICE strategy for first-trimester preterm PE screening in the UK.