Park F, Deeming S, Bennett N, Hyett J
Department of Maternal Fetal Medicine, John Hunter Hospital, Newcastle, Australia.
Health Research Economics, Hunter Medical Research Institute, Newcastle, Australia.
Ultrasound Obstet Gynecol. 2021 Nov;58(5):688-697. doi: 10.1002/uog.22193. Epub 2021 Oct 19.
Pre-eclampsia (PE) causes substantial maternal and neonatal mortality and morbidity. In addition to the personal impact on women, children and their families, PE has a significant economic impact on our society. Recent research suggests that a first-trimester multivariate model is highly predictive of preterm (< 37 weeks' gestation) PE and can be combined successfully with targeted prophylaxis (low-dose aspirin), resulting in an 80% reduction in prevalence of disease. The aim of this study was to examine the potential health outcomes and cost implications following introduction of first-trimester prediction and prevention of preterm PE within a public healthcare setting, compared with usual care, and to conduct a cost-effectiveness analysis to inform health-service decisions regarding implementation of such a program.
A decision-analytic model was used to compare usual care with the proposed first-trimester screening intervention within the obstetric population (n = 6822) attending two public hospitals within a metropolitan district health service in New South Wales, Australia, between January 2015 and December 2016. The model, applied from early pregnancy, included exposure to a variety of healthcare professionals and addressed type of risk assessment (usual care or first-trimester screening) and use of (compliance with) low-dose aspirin prescribed prophylactically for prevention of PE. All pathways culminated in six possible health outcomes, ranging from no PE to maternal death. Results were presented as the number of cases of PE gained/avoided and the incremental increase/decrease in economic costs arising from the intervention compared with usual care. Significant assumptions were tested in sensitivity/uncertainty analyses.
The intervention produced, across all gestational ages, 31 fewer cases of PE and reduced aggregate economic health-service costs by 1 431 186 Australian dollars over the 2-year period. None of the tested iterations of uncertainty analyses reported additional cases of PE or higher economic costs. The new intervention based on first-trimester screening dominated usual care.
This cost-effectiveness analysis demonstrated a reduction in prevalence of preterm PE and substantial cost savings associated with a population-based program of first-trimester prediction and prevention of PE, and supports implementation of such a policy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
子痫前期（PE）导致大量孕产妇和新生儿死亡及发病。除了对妇女、儿童及其家庭的个人影响外，PE对我们的社会也有重大经济影响。近期研究表明，孕早期多变量模型对早产（孕周<37周）PE具有高度预测性，并且可以成功地与靶向预防措施（低剂量阿司匹林）相结合，使疾病患病率降低80%。本研究的目的是与常规护理相比，研究在公共医疗环境中引入孕早期早产PE预测和预防措施后的潜在健康结局和成本影响，并进行成本效益分析，为关于实施此类计划的卫生服务决策提供依据。
采用决策分析模型，对2015年1月至2016年12月期间在澳大利亚新南威尔士州一个大都市地区卫生服务机构内的两家公立医院就诊的产科人群（n = 6822）中的常规护理与拟议的孕早期筛查干预措施进行比较。该模型从妊娠早期开始应用，包括接触各种医疗保健专业人员，并涉及风险评估类型（常规护理或孕早期筛查）以及预防性使用（依从性）低剂量阿司匹林预防PE。所有路径最终导致六种可能的健康结局，从不发生PE到孕产妇死亡。结果以获得/避免的PE病例数以及与常规护理相比干预措施导致的经济成本的增量增加/减少来呈现。在敏感性/不确定性分析中对重要假设进行了检验。
在所有孕周中，该干预措施使PE病例减少了31例，并在2年期间使总体经济卫生服务成本降低了1431186澳元。不确定性分析的所有测试迭代均未报告额外的PE病例或更高的经济成本。基于孕早期筛查的新干预措施优于常规护理。
这项成本效益分析表明，基于人群的孕早期PE预测和预防计划可降低早产PE的患病率并节省大量成本，并支持实施此类政策。© 2020国际妇产科超声学会。
