Enhancing the value of the sFlt-1/PlGF ratio for the prediction of preeclampsia: Cost analysis from the Belgian healthcare payers' perspective.

Frederic Chantraine,Leonardo Gucciardo,Roland Devlieger,Ana Dubon Garcia,Katleen Vandeweyer,Kristel Van Calsteren,Damien Gruson,Joachim Van Keirsbilck

doi:10.1016/j.preghy.2021.08.113

Frederic Chantraine, Leonardo Gucciardo + Show 6 more

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https://doi.org/10.1016/j.preghy.2021.08.113

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Abstract

To evaluate the economic impact of introducing the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test into clinical practice in Belgium for the prediction of preeclampsia (PE). We developed a one-year time-horizon decision tree model to evaluate the short-term costs associated with the introduction of the sFlt-1/PlGF test for guiding the management of women with suspected PE from the Belgian public healthcare payers' perspective. The model estimated the costs associated with the diagnosis and management of PE in pregnant women managed in either a test scenario, in which the sFlt-1/PlGF test is used in addition to current clinical practice, or a no test scenario, in which clinical decisions are based on current practice alone. Test characteristics were derived from PROGNOSIS, a non-interventional study in women presenting with clinical suspicion of PE. Unit costs were obtained from Belgian-specific sources. The main model outcome was the total cost per patient. Introduction of the sFlt-1/PlGF ratio test is expected to result in a cost saving of €712 per patient compared with the no test scenario. These savings are generated mainly due to a reduction in unnecessary hospitalizations. The sFlt-1/PlGF test is projected to result in substantial cost savings for the Belgian public healthcare payers through reduction of unnecessary hospitalization of women with clinical suspicion of PE that ultimately do not develop the condition. The test also has the potential to ensure that women at high risk of developing PE are identified and appropriately managed.

Highlights

Preeclampsia (PE) is a major cause of maternal and fetal morbidity, long-term disability, and death worldwide, affecting 2–8% of all preg nancies and contributing to 10–15% of all maternal deaths [1,2,3]
Base case analyses The model shows that additional information provided by the test may result in more appropriate decisions related to the management of women with suspected PE when compared with the current diagnostic procedures alone
The increase in the percentage of hospitalized women who went on to develop PE when using the ratio test highlights a reduction in false positives; standard of care (SOC) results in 26.57% false-positive outcomes, while use of the test reduces this to 12.54%

Summary

Introduction

Preeclampsia (PE) is a major cause of maternal and fetal morbidity, long-term disability, and death worldwide, affecting 2–8% of all preg nancies and contributing to 10–15% of all maternal deaths [1,2,3]. The management of PE is associated with significant healthcare costs [8,9]. Women already diagnosed with PE will be managed in an inpatient setting and those with suspected PE may be hospitalized. As a result of the uncertainty in confirming diagnosis, those with suspected PE may be unnecessarily hospitalized, leading to further substantial healthcare costs [10]. And accurate diagnosis of PE is required, both to improve patient man agement and outcomes for the mother and fetus, as well as to reduce costs

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