Key result
Universal aspirin administration dominated all other strategies, resulting in fewer cases of preeclampsia and lower costs compared to no aspirin, USPSTF guidelines, or biomarker/ultrasound screening.
Why the study?
To evaluate the cost effectiveness of various preeclampsia screening and aspirin prophylaxis strategies, including a strategy based on biomarker and ultrasound measures.
Does universal aspirin use reduce preeclampsia-related costs and cases in pregnant women compared to targeted screening or no aspirin?
Does universal aspirin use reduce preeclampsia-related costs and cases in pregnant women compared to targeted screening or no aspirin?
A decision analysis suggests that universal aspirin administration in pregnancy is more effective and less costly for preventing preeclampsia than screening-based strategies or no aspirin.
Answers are grounded in this paper and cite their sources.
May support universal aspirin in decision models; leaves open prospective validation of costs and outcomes.
OBJECTIVE: To evaluate the cost effectiveness of various preeclampsia screening and aspirin prophylaxis strategies, including a strategy based on biomarker and ultrasound measures. METHODS: We designed a decision analysis to compare preeclampsia-related costs and effects of four strategies for aspirin use in pregnancy initiated before 16 weeks of gestation to prevent preeclampsia. The four strategies were: 1) no aspirin use, 2) biomarker and ultrasound measure-predicated use, 3) use based on the U.S. Preventive Services Task Force guidelines, and 4) universal aspirin use. Our outcomes were preeclampsia-related costs and number of cases per 100,000 pregnant women. Using a threshold of $90,843 per case of preeclampsia, one-way, two-way, and Monte-Carlo sensitivity analyses incorporating varying probabilities of risk reduction due to aspirin use, aspirin-related side effects, and costs were performed to identify ranges at which costs and risks of aspirin-related complications shifted the preferred strategy. RESULTS: Compared with universal aspirin administration, the use of U.S. Preventive Services Task Force guidelines is associated with $8,011,725 higher health care costs and 346 additional cases of preeclampsia per 100,000 pregnant women; biomarker and ultrasound screening is associated with an additional $19,216,551 and 308 additional cases. Similarly, no aspirin use is associated with an increased cost of $18,750,381 and 762 additional cases. Thus, universal aspirin use dominated all three other strategies. In a Monte Carlo simulation of 10,000 pregnant women, universal aspirin was the preferred strategy in 91% of simulations. The U.S. Preventive Task Force screen was preferred in 8.5% of simulations, and biomarker and ultrasound screening and no aspirin were preferred in 0% and 0.5% of simulations, respectively. CONCLUSION: Over a broad range of assumptions, universal aspirin administration is associated with fewer cases of preeclampsia and fewer costs relative to no aspirin administration and aspirin administration based on serum and ultrasound measures or clinical risk factors.
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Mallampati et al. (2019) studied Preeclampsia (n=100,000). Universal aspirin use vs. No aspirin, USPSTF guidelines, or biomarker/ultrasound screening was evaluated on Preeclampsia-related costs and number of cases per 100,000 pregnant women. Universal aspirin administration dominated all other strategies, resulting in fewer cases of preeclampsia and lower costs compared to no aspirin, USPSTF guidelines, or biomarker/ultrasound screening.
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