Which first-trimester risk assessment method for preeclampsia is most suitable? A model-based impact study

BACKGROUND: Low-dose aspirin treatment reduces the risk of pre-eclampsia among high-risk pregnant women. Internationally, several first-trimester risk-calculation methods are applied. OBJECTIVE: This study aimed to assess the costs and benefits of dif-ferent first-trimester preeclampsia risk estimation algorithms: EXPECT (an algorithmic prediction model based on maternal characteristics), National Institute for Health and Care Excellence (a checklist of risk factors), and the Fetal Medicine Foundation (a prediction model using additional uterine artery Doppler measurement and laboratory testing) models, coupled with low-dose aspirin treatment, in comparison with no risk assessment. STUDY DESIGN: We constructed a decision analytical model estimat-ing the number of cases of preeclampsia with each strategy and the costs of risk assessment for preeclampsia and early aspirin treatment, expressed in euros (euro) in a hypothetical population of 100,000 women. We performed 1-way sensitivity analyses to assess the impact of adher-ence rates on model outcomes.RESULTS: Application of the EXPECT, National Institute for Health and Care Excellence, and Fetal Medicine Foundation models results in respec-tively 1.98%, 2.55%, and 1.90% of the women developing preeclampsia, as opposed to 3.00% of women in the case of no risk assessment. Over-all, the net financial benefits of the EXPECT, National Institute for Health and Care Excellence, and Fetal Medicine Foundation models relative to no risk assessment are euro144, euro43, and euro38 per patient, respectively. The respective percentages of women receiving aspirin treatment are 18.6%, 10.2%, and 6.0% for the 3 risk assessment methods.CONCLUSION: The EXPECT and Fetal Medicine Foundation model are comparable with regard to numbers of prevented preeclampsia cases, and both are superior to the National Institute for Health and Care Excel-lence model and to no risk assessment. EXPECT is less resource-demand-ing and results in the highest cost savings, but also requires the highest number of women to be treated with aspirin. When deciding which strat-egy is preferable, cost savings and easier use have to be weighed against the degree of overtreatment, although low-dose aspirin has no clear disad-vantages during pregnancy.

Automated summary

This study assessed the costs and benefits of different first-trimester preeclampsia risk estimation algorithms coupled with low-dose aspirin treatment. The EXPECT and Fetal Medicine Foundation models showed similar effectiveness in preventing preeclampsia, while the National Institute for Health and Care Excellence model and no risk assessment were inferior. The EXPECT model resulted in the highest cost savings, but also required the highest number of women to be treated with aspirin.