Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany

Abstract

BackgroundThe PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the next 4 weeks. We performed an assessment of the economic impact of the sFlt-1/PlGF ratio test for short-term prediction of preeclampsia in Germany.MethodsWe adapted a cost-effectiveness model, which had been developed to estimate the incremental value of adding the sFlt-1/PlGF ratio test with a cut-off ratio of 38 to standard diagnostic procedures for guiding the management of women with suspected preeclampsia in the UK. We used the adapted model to estimate the incremental value of the sFlt-1/PlGF ratio test (cut-off 38) for guiding the management of women with suspected preeclampsia from a German Diagnosis-Related Group (DRG) payer perspective. The economic model estimated costs associated with diagnosis and management of preeclampsia in women managed in either a ‘no-test’ scenario in which clinical decisions are based on standard diagnostic procedures alone, or a ‘test’ scenario in which the sFlt-1/PlGF test is used in addition to standard diagnostic procedures. Test characteristics and rates of hospitalization were derived from patient-level data from PROGNOSIS. The main outcome measure from the economic model was the total cost per patient.ResultsIn the model adapted to the German DRG payer system, introduction of the sFlt-1/PlGF ratio test with a cut-off value of 38 could reduce the proportion of women hospitalized in Germany from 44.6 to 24.0%, resulting in an expected cost saving of €361 per patient.ConclusionsThe sFlt-1/PlGF ratio test is likely to reduce unnecessary hospitalization of women with a low risk of developing preeclampsia, and identify those at high risk to ensure appropriate management. Even within the restrictions of the DRG system in Germany, this results in substantial cost savings for women with suspected preeclampsia.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3406-1) contains supplementary material, which is available to authorized users.

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

“…Furthermore, this is the first analysis to assess the cost of preeclampsia patients in Switzerland. Notably, the analysis included birth costs; by excluding them, total costs would have been lower (as seen the in the UK [14] and German studies [15]). However, the inclusion of birth costs (based on registry values), which differ for patients with or without preeclampsia, provides a more complete picture of the impact of preeclampsia on the Swiss healthcare system.…”

“…Previously, Vatish et al (2016), Schlembach et al (2018), and Frusca et al (2017) published economic assessments of the use of the sFlt-1/PlGF ratio for the prediction of preeclampsia in the UK [14], Germany [15], and Italy [16], respectively. Patient-level data were taken from the PROGNOSIS study, and country-specific economic models were developed.…”

Maternal health and non‐communicable disease prevention: An investment case for the post COVID‐19 world and need for better health economic data

“…59 Other studies show similar findings. [60][61][62][63][64] These recent studies should also be compared with the findings…”

From first‐trimester screening to risk stratification of evolving pre‐eclampsia in second and third trimesters of pregnancy: comprehensive approach

“…Indeed, NICE has been recommending since 2016 the use of the sFlt-1/PlGF ratio, or the PlGF marker alone, to help rule out pre-eclampsia in women presenting with signs and symptoms of the disorder between 20 + 0 and 34 + 6 weeks of gestation 56 . A number of studies have examined the cost-effectiveness of triaging women suspected of having pre-eclampsia with this test and have shown that adoption of this tool potentially reduces the cost burden to the healthcare system 57,58 .…”