Landman Anadeijda J E M C, Broulikova Hana M, Visser Laura, Nijman Tobias A J, Hemels Marieke A C, Vollebregt Karin C, Boormans Elisabeth M A, Bremer Henk A, Tuinman Esther, Langenveld Josje, van der Made Flip, Rijnders Robbert J P, van Vliet Huib A A M, Freeman Liv M, de Heus Roel, Blaauw Judith, Krabbendam Ineke, van de Laar Rafli, Verberg Marieke F G, Scheepers Hubertina C J, Mol Ben W, de Groot Christianne J M, Oudijk Martijn A, Bosmans Judith E, de Boer Marjon A
Department of Obstetrics and Gynecology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Int J Gynaecol Obstet. 2025 Apr;169(1):399-407. doi: 10.1002/ijgo.16024. Epub 2024 Nov 28.
To assess the cost-effectiveness of low-dose aspirin compared to placebo for the prevention of recurrent preterm birth from a healthcare perspective. This was a cost-effectiveness analysis alongside a multicenter, randomized, double-blinded, placebo-controlled trial. We included women with a singleton pregnancy and a previous spontaneous preterm birth <37 weeks of gestation of a singleton. Women were randomized between aspirin 80 mg daily and placebo, initiated between 8 and 16 weeks of gestation. We estimated the difference in preterm births (<37 weeks of gestation), and maternal and neonatal healthcare costs using seemingly unrelated linear regression analyses. Bootstrapping was performed to estimate statistical uncertainty. A total of 387 women were included: 194 in the aspirin group and 193 in the placebo group. We observed a small, statistically non-significant difference in preterm birth (21.2% vs. 25.4%; risk difference -4.3%; 95% CI: -12.7% to 4.1%) and healthcare costs (mean -€99; 95% CI: -€2385 to €2325) in the aspirin group compared to placebo. The cost-effectiveness acceptability curve showed that the probability of aspirin being cost-effective was 54% for a willingness to pay threshold of €0 for one prevented preterm birth and 78% for €50 000 for one prevented preterm birth. Our findings suggest that aspirin is the dominant strategy over placebo for the prevention of preterm birth. However, there was substantial uncertainty around the results and definite conclusions regarding the cost-effectiveness of aspirin cannot be drawn.
从医疗保健角度评估低剂量阿司匹林与安慰剂相比预防复发性早产的成本效益。这是一项成本效益分析，同时进行了一项多中心、随机、双盲、安慰剂对照试验。我们纳入了单胎妊娠且既往有单胎妊娠<37周自发早产史的女性。女性在妊娠8至16周之间被随机分为每日服用80毫克阿司匹林组和安慰剂组。我们使用看似不相关的线性回归分析估计早产（<37周妊娠）、孕产妇和新生儿医疗保健成本的差异。进行了自举法以估计统计不确定性。总共纳入了387名女性：阿司匹林组194名，安慰剂组193名。与安慰剂组相比，我们观察到阿司匹林组在早产（21.2%对25.4%；风险差异-4.3%；95%置信区间：-12.7%至4.1%）和医疗保健成本（平均-99欧元；95%置信区间：-2385欧元至2325欧元）方面存在微小的、统计学上无显著差异。成本效益可接受性曲线显示，对于预防一例早产的支付意愿阈值为0欧元时，阿司匹林具有成本效益的概率为54%，对于预防一例早产的支付意愿阈值为50000欧元时，该概率为78%。我们的研究结果表明，在预防早产方面，阿司匹林比安慰剂更具优势。然而，结果存在很大的不确定性，无法就阿司匹林的成本效益得出明确结论。
