750: Do the new hypertension guidelines Impact the use of aspirin in pregnancy?

Abstract

In November 2017 American College of Cardiology (ACC) and American Heart Association (AHA) published new guidelines which lower the cut-off for hypertension. There has been no study that evaluate the cost-benefit of expanding the eligibility of aspirin with a lower cut-off for the definition of chronic hypertension. Our objective in this study was to develop a decision model to evaluate the impact of new ACC/AHA hypertension guidelines to the risks, benefits and costs of several low-dose aspirin prophylaxis approaches for preeclampsia prevention. We created a decision tree analysis to evaluate four approaches to aspirin prophylaxis in the United States: no aspirin, USPSTF with old ACC/AHA hypertension guidelines, USPSTF with new ACC/AHA hypertension guidelines as well as universal aspirin prophylaxis. To build this model PubMed literature review was performed to find a range for various clinical parameters pertinent to the model. We accounted for cost of aspirin, cost of medication side effects, adverse events and hypersensitivity reaction. Benefits were derived from aspirin-related obstetrical complications risks reduction, including preeclampsia, preterm birth as well as perinatal and neonatal death. This model was executed to simulate a hypothetical cohort of 4 million pregnant women in the United States. Based on our simulation model, the new hypertension guidelines would expand the aspirin eligibility by 8% (76,953 women) in the USPSTF guidelines. We also showed that even with this increased eligibility, USPSTF guidelines continues to be the approach with the most cost savings ($386.5 million) when compared to no aspirin and universal aspirin approaches ($373.2 million). The new hypertension guidelines are projected to increase the cost savings of the USPSTF approach by $9.4 million. The increased prevalence of chronic hypertension due to the change in hypertension cut-off is expected to increase the eligibility of aspirin prophylaxis for preeclampsia by 8%. Despite the small change in aspirin prophylaxis, it still results in an annual cost-saving of $9.4 million in the United States.