Placental Growth Factor (PlGF) in Women with Suspected Pre-Eclampsia Prior to 35 Weeks' Gestation: A Budget Impact Analysis.

Suzy Duckworth,Lucy C Chappell,Andrew H Shennan,Lucy Mackillop,Rachael Hunter,Paul T Seed,Anne Croy

doi:10.1371/journal.pone.0164276

Abstract

ObjectiveTo model the resource implications of placental growth factor (PlGF) testing in women with suspected pre-eclampsia prior to 35 weeks’ gestation as part of a management algorithm, compared with current practice.MethodsData on resource use from 132 women with suspected pre-eclampsia prior to 35 weeks’ gestation, enrolled in a prospective observational cohort study evaluating PlGF measurement within antenatal assessment units within two UK consultant-led maternity units was extracted by case note review. A decision analytic model was developed using these data to establish the budget impact of managing women with suspected pre-eclampsia for two weeks from the date of PlGF testing, using a clinical management algorithm and reference cost tariffs. The main outcome measures of resource use (numbers of outpatient appointments, ultrasound investigations and hospital admissions) were correlated to final diagnosis and used to calculate comparative management regimes.ResultsThe mean cost saving associated with the PlGF test (in the PlGF plus management arm) was £35,087 (95% CI -£33,181 to -£36,992) per 1,000 women. This equated to a saving of £582 (95% CI -552 to -£613) per woman tested. In 94% of iterations, PlGF testing was associated with cost saving compared to current practice.ConclusionsThis analysis suggests PlGF used as part of a clinical management algorithm in women presenting with suspected pre-eclampsia prior to 35 weeks’ gestation could provide cost savings by reducing unnecessary resource use. Introduction of PlGF testing could be used to direct appropriate resource allocation and overall would be cost saving.

Highlights

Pre-eclampsia complicates 4–8% of pregnancies. [1] Diagnosis is time consuming and resource intensive
This analysis suggests placental growth factor (PlGF) used as part of a clinical management algorithm in women presenting with suspected pre-eclampsia prior to 35 weeks’ gestation could provide cost
PlGF in Suspected Pre-Eclampsia: A Budget Impact Analysis any role in study design, patient recruitment, data collection, analysis, interpretation, nor in writing of the manuscript or decision to submit for publication

Summary

Introduction

Pre-eclampsia complicates 4–8% of pregnancies. [1] Diagnosis is time consuming and resource intensive. In women with suspected pre-eclampsia, current clinical management requires highcost monitoring, fetal surveillance, [1] and medical management. This increases the likelihood of antenatal admission and possible iatrogenic preterm delivery. [5,6,7] In normal pregnancy, placental growth factor (PlGF) concentrations increase with gestation, with concentrations peaking at 26–30 weeks [6] and declining towards term. We have recently conducted a prospective multicentre study, investigating the diagnostic accuracy of PlGF concentration in women presenting with signs and/or symptoms suggestive of preeclampsia in the second half of pregnancy. The introduction of PlGF testing could target those women at greatest risk for increased surveillance, whilst avoiding unnecessary intervention and resource use in those with subsequent normal outcomes

Methods

Discussion

Conclusion