Cost-Effectiveness of First Trimester Screening for Preterm Pre-eclampsia in Lebanon

Abstract

To estimate, for Lebanon, the financial benefit of screening for preterm pre-eclampsia (PE) at 11–13 weeks gestation combining risk factors with mean arterial pressure and maternal serum placental growth factor. Preterm PE cases delivered during 2010–2018 at Rafik Hariri University Hospital were identified from electronic records. Manual nursing notes were reviewed to confirm the diagnosis using international criteria. For each case, adverse maternal and infant events were noted and billing information extracted. A series of 1000 non-PE pregnancies were identified and billing information recorded. Published screening detection rates for a 10% false-positive rate and the proportion prevented by aspirin prophylaxis were applied to estimate the reduced cost following screening. There were a total of 17,131 deliveries including 486 (2.84%) PE and 223 (1.30%) preterm PE cases. The caesarean section rate was substantially higher for preterm PE (74%) than non-PE deliveries (36%) and 76% of infants were admitted to the Newborn Intensive Care Unit, where the average stay was 32, 21 and 8 days for deliveries before 32, 32–33 and 34–36 weeks respectively. The total cost of maternal and infant care for preterm PE was $881,206 and the average cost of an unaffected delivery $599. It was estimated that following screening the saving in treatment costs including aspirin would have been $431,665, which is $24 per woman delivering at the hospital over the nine year period. The financial savings are more than sufficient to pay for the screening test in those who are screen-positive.

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Correspondence to H. Karaki.

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HK is an employee of HVD Life Sciences GmbH and HC is a consultant to PerkinElmer Inc; both companies provide reagents for maternal serum preeclampsia tests. Other authors have no conflict of interest.

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Karaki, H., Khazaal, J., Chahine, R. et al. Cost-Effectiveness of First Trimester Screening for Preterm Pre-eclampsia in Lebanon. J. Fetal Med. 7, 119–123 (2020). https://doi.org/10.1007/s40556-019-00236-4

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Keywords

  • Screening
  • Pre-eclampsia
  • Early pregnancy
  • Cost-effective
  • PlGF