Abstract
BackgroundThe PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the next 4 weeks. We performed an assessment of the economic impact of the sFlt-1/PlGF ratio test for short-term prediction of preeclampsia in Germany.MethodsWe adapted a cost-effectiveness model, which had been developed to estimate the incremental value of adding the sFlt-1/PlGF ratio test with a cut-off ratio of 38 to standard diagnostic procedures for guiding the management of women with suspected preeclampsia in the UK. We used the adapted model to estimate the incremental value of the sFlt-1/PlGF ratio test (cut-off 38) for guiding the management of women with suspected preeclampsia from a German Diagnosis-Related Group (DRG) payer perspective. The economic model estimated costs associated with diagnosis and management of preeclampsia in women managed in either a ‘no-test’ scenario in which clinical decisions are based on standard diagnostic procedures alone, or a ‘test’ scenario in which the sFlt-1/PlGF test is used in addition to standard diagnostic procedures. Test characteristics and rates of hospitalization were derived from patient-level data from PROGNOSIS. The main outcome measure from the economic model was the total cost per patient.ResultsIn the model adapted to the German DRG payer system, introduction of the sFlt-1/PlGF ratio test with a cut-off value of 38 could reduce the proportion of women hospitalized in Germany from 44.6 to 24.0%, resulting in an expected cost saving of €361 per patient.ConclusionsThe sFlt-1/PlGF ratio test is likely to reduce unnecessary hospitalization of women with a low risk of developing preeclampsia, and identify those at high risk to ensure appropriate management. Even within the restrictions of the DRG system in Germany, this results in substantial cost savings for women with suspected preeclampsia.
Highlights
The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor ratio ≤ 38 ruled out the occurrence of preeclampsia in the week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the 4 weeks
Cost analyses The model shows that additional information provided by the soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) test ratio result in management decisions for women with suspected preeclampsia that are better correlated with preeclampsia outcomes than current diagnostic procedures alone
We show that use of sFlt-1/PlGF ratio values of ≤ 38 would reduce the proportion of women hospitalized to 24.0%, which could potentially translate into a substantial reduction in burden on the German healthcare system
Summary
The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the 4 weeks. Occurring in 6–8% of pregnancies and increasing, hypertensive disorders are the most common cause of maternal death in Europe, contributing to 20–25% of perinatal mortality [1, 2]. Preeclampsia, defined as new-onset hypertension and proteinuria or other maternal organ dysfunction, after 20 weeks of gestation [9], complicates approximately 2% of pregnancies [10,11,12] and is associated with substantial perinatal morbidity and mortality in mothers and infants [12]. Adverse outcomes are more common in future pregnancies in women who have experienced preeclampsia [21, 22]
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