Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
PLoS One. 2022 Apr 21;17(4):e0267313. doi: 10.1371/journal.pone.0267313. eCollection 2022.
Preeclampsia causes substantial maternal and perinatal morbidity and mortality and significant societal economic impact. Effective screening would facilitate timely and appropriate prevention and management of preeclampsia.
To develop an early cost-effectiveness analysis to assess both costs and health outcomes of a new screening test for preeclampsia from a healthcare payer perspective, in the United Kingdom (UK), Ireland, the Netherlands and Sweden.
A decision tree over a 9-month time horizon was developed to explore the cost-effectiveness of the new screening test for preeclampsia compared to the current screening strategy. The new test strategy is being developed so that it can stratify healthy low risk nulliparous women early in pregnancy to either a high-risk group with a risk of 1 in 6 or more of developing preeclampsia, or a low-risk group with a risk of 1 in 100 or less. The model simulated 25 plausible scenarios in a hypothetical cohort of 100,000 pregnant women, in which the sensitivity and specificity of the new test were varied to set a benchmark for the minimum test performance that is needed for the test to become cost-effective. The input parameters and costs were mainly derived from published literature. The main outcome was incremental costs per preeclampsia case averted, expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty.
Base case results showed that the new test strategy would be more effective and less costly compared to the current situation in the UK. In the Netherlands, the majority of scenarios would be cost-effective from a threshold of €50,000 per preeclampsia case averted, while in Ireland and Sweden, the vast majority of scenarios would be considered cost-effective only when a threshold of €100,000 was used. In the best case analyses, ICERs were more favourable in all four participating countries. Aspirin effectiveness, prevalence of preeclampsia, accuracy of the new screening test and cost of regular antenatal care were identified as driving factors for the cost-effectiveness of screening for preeclampsia.
The results indicate that the new screening test for preeclampsia has potential to be cost-effective. Further studies based on proven accuracy of the test will confirm whether the new screening test is a cost-effective additional option to the current situation.
子痫前期会导致产妇和围产儿发病率和死亡率显著增加，并对社会经济造成重大影响。有效的筛查将有助于及时和适当的预防和管理子痫前期。
从医疗保健支付者的角度出发，在英国、爱尔兰、荷兰和瑞典，开发一种新的子痫前期筛查的早期成本效益分析，以评估其成本和健康结果。
在 9 个月的时间范围内，开发了一个决策树，以探索新的子痫前期筛查测试与当前筛查策略相比的成本效益。新的测试策略旨在将健康的低危初产妇早期分层为高危组（子痫前期风险为 1/6 或更高）或低危组（子痫前期风险为 1/100 或更低）。该模型模拟了 100,000 名孕妇的假设队列中的 25 种可能情况，其中改变了新测试的敏感性和特异性，以确定新测试需要达到的最低性能基准，以使其具有成本效益。输入参数和成本主要来自已发表的文献。主要结果是每例子痫前期病例避免的增量成本，以增量成本效益比（ICER）表示。进行了确定性和概率敏感性分析以评估不确定性。
基础案例结果表明，与英国目前的情况相比，新的测试策略将更有效且成本更低。在荷兰，从避免子痫前期病例的成本阈值为 50,000 欧元起，大多数方案都具有成本效益，而在爱尔兰和瑞典，只有当使用 100,000 欧元的阈值时，绝大多数方案才被认为具有成本效益。在最佳案例分析中，所有四个参与国家的 ICER 都更为有利。阿司匹林的有效性、子痫前期的患病率、新筛查测试的准确性和常规产前护理的成本被确定为子痫前期筛查成本效益的驱动因素。
结果表明，新的子痫前期筛查测试具有成本效益的潜力。基于该测试的准确性的进一步研究将证实新的筛查测试是否是当前情况的一种具有成本效益的附加选择。
