First Trimester Screening for Preterm Preeclampsia in the United Kingdom: A Cost-Effectiveness Analysis.

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.