Cost effectiveness of the sFlt1/PlGF ratio test as an adjunct to the current practice of evaluating suspected preeclampsia in the United States

Preeclampsia is a major obstetric disorder that can lead to severe maternal, fetal and infant outcomes. In women with suspected preeclampsia, measurement of the soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) ratio has been shown to have a high negative predictive value...

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Bibliographic Details
Published in:	Pregnancy hypertension Vol. 26; pp. 121 - 126
Main Authors:	Khosla, Kavia, Espinoza, Jimmy, Perlaza, Lauren, Gencay, Mikael, Mueller, Ariel L., Harris, James M., Wolf, Cyrill, Posnett, John W., Woelkers, Douglas A., Rana, Sarosh
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-12-2021
Subjects:	Adult Cost effectiveness Cost-Benefit Analysis Diagnostic Techniques, Obstetrical and Gynecological - economics Female Health Care Costs - statistics & numerical data Humans Placenta Growth Factor - blood Pre-Eclampsia - blood Pre-Eclampsia - diagnosis Pre-Eclampsia - economics Predictive Value of Tests Preeclampsia Pregnancy Risk Assessment - methods sFlt/PlGF ratio United States Vascular Endothelial Growth Factor Receptor-1 - blood United States COVID-19 sFlt1 HELLP Cost effectiveness United States Preeclampsia NICE sFlt/PlGF ratio PlGF
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Summary:	Preeclampsia is a major obstetric disorder that can lead to severe maternal, fetal and infant outcomes. In women with suspected preeclampsia, measurement of the soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) ratio has been shown to have a high negative predictive value (>97%). Our aim was to estimate the value to the US healthcare system of adopting this test into clinical practice. Study design: An economic model was developed for the evaluation of suspected preeclampsia from a US payer perspective using data from a US observational study of 459 women evaluated between 23 and 34.6 weeks. Test results were not available to clinicians. The model compares two strategies for managing suspected preeclampsia: standard care versus a biomarker-informed pathway utilizing the sFlt1/PlGF ratio. Utilization of the sFlt1/PlGF ratio test reduced the number of women admitted for suspected preeclampsia by 34–49%. Despite fewer admissions, a higher proportion of women admitted to hospital subsequently developed preeclampsia, and the proportion of women not admitted who would subsequently develop preeclampsia remained low (3.2%–6.7%). Cost savings arising from a reduction in admissions are estimated to be $1050 in the base case; varying the hospitalization cost ±25% would lead to savings in the range $771 to $1330 per patient at 2020 prices. Adopting the sFlt1/PlGF ratio test as an adjunct to clinical criteria improves the assessment of risk in women presenting with suspicion of preeclampsia and has the potential to safely reduce unnecessary admissions and save costs.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	2210-7789 2210-7797
DOI:	10.1016/j.preghy.2021.10.009