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BACKGROUND: Pre-eclampsia is a major contributor to maternal and neonatal morbidity and mortality. Our objectives in this study are to economically assess, from the payer perspective, routine screening for pre-eclampsia using placental markers -placental protein 13 and placental growth factor - and uterine artery Doppler compared with standard care. METHODS: A decision model was developed, which progresses through three sequential endpoints, and compares screening with no screening: (1) Pre-eclampsia yes/no: calculation of the incremental cost of pre-eclampsia-case averted; (2) Hospital discharge: calculation of the mean accumulated costs until discharge after delivery; and (3) Offspring death: calculation of the incremental cost per quality of life-adjusted life-year gained by screening. Data used includes: (1) Obstetrical data of 14 500 births; (2) cost data from the Israeli Ministry of Health and the literature; and (3) screening performance and outcome from the literature. RESULTS: (1) The incremental cost of pre-eclampsia-case averted is 66, 949 and 24, 723 when the prevalence is 1. 7 and 5% respectively. (2) With test cost of 112, the total cost until discharge with/without screening is equal. With pre-eclampsia prevalence of 3%, screening is cheaper. (3) The cost per quality of life-adjusted life-year with screening is 18, 919 and < 10, 000 with pre-eclampsia prevalence of 1. 7 and 3%, respectively. CONCLUSIONS: Screening for pre-eclampsia is cost-effective under various scenarios.
Shmueli et al. (Sun,) studied this question.