SFlt-1/PlGF Ratio as a Predictive Marker in Women with Suspected Preeclampsia: An Economic Evaluation from a Swiss Perspective.

Markus Hodel,Patricia R Blank,Olav Lapaire,Petra Marty

doi:10.1155/2019/4096847

Markus Hodel, Patricia R Blank + Show 2 more

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https://doi.org/10.1155/2019/4096847

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Abstract

In Switzerland, 2.3% of pregnant women develop preeclampsia. Quantification of the soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) ratio has shown a diagnostic value in the second and third trimesters of pregnancy, in particular in ruling out preeclampsia within one week. We estimated the economic impact of implementing sFlt-1/PlGF ratio evaluation, in addition to the standard of care (SOC), for women with suspected preeclampsia from a Swiss healthcare system's perspective. A decision tree model was developed to estimate direct medical costs of diagnosis and management of a simulated cohort of Swiss pregnant women with suspected preeclampsia (median week of gestation: 32) until delivery. The model compared SOC vs. SOC plus sFlt-1/PlGF ratio, using clinical inputs from a large multicenter study (PROGNOSIS). Resource use data and unit costs were obtained from hospital records and public sources. The assumed cost for sFlt-1/PlGF evaluation was €141. Input parameters were validated by clinical experts in Switzerland. The model utilized a simulated cohort of 6084 pregnant women with suspected preeclampsia (representing 7% of all births in Switzerland in 2015, n = 86,919). In a SOC scenario, 36% of women were hospitalized, of whom 27% developed preeclampsia and remained hospitalized until birth. In a sFlt-1/PlGF test scenario, 76% of women had a sFlt-1/PlGF ratio of ≤38 (2% hospitalized), 11% had a sFlt-1/PlGF ratio of >38-<85 (55% hospitalized), and 13% had a sFlt-1/PlGF ratio of ≥85 (65% hospitalized). Total average costs/pregnant woman (including birth) were €10,925 vs. €10,579 (sFlt-1/PlGF), and total costs were €66,469,362 vs. €64,363,060 (sFlt-1/PlGF). Implementation of sFlt-1/PlGF evaluation would potentially achieve annual savings of €2,105,064 (€346/patient), mainly due to reduction in unnecessary hospitalization. sFlt-1/PlGF evaluation appears economically promising in predicting short-term absence of preeclampsia in Swiss practice. Improved diagnostic accuracy and reduction in unnecessary hospitalization could lead to significant cost savings in the Swiss healthcare system.

Highlights

Preeclampsia is a disorder of pregnancy, defined as the onset of hypertension, proteinuria, or other maternal organ dysfunctions after 20 weeks of gestation [1, 2]
Studies have shown that the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (PlGF) is elevated in preeclampsia and is raised even before clinical onset of the disease [7, 8]
We developed an Excel-based decision tree model to estimate the direct medical costs of diagnosis and management of pregnant women with suspected preeclampsia, including delivery, based on the assumption suspected and manifest preeclampsia that occurs in 7% of all pregnancies [18]

Summary

Introduction

Preeclampsia is a disorder of pregnancy, defined as the onset of hypertension, proteinuria, or other maternal organ dysfunctions after 20 weeks of gestation [1, 2]. Studies have shown that the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) is elevated in preeclampsia and is raised even before clinical onset of the disease [7, 8]. This ratio has been used successfully in clinical trials to improve prediction of preeclampsia for women at risk of this condition [9, 10].

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