Enhancing the value of the sFlt-1/PlGF ratio for the prediction of preeclampsia: Cost analysis from the Belgian healthcare payers’ perspective

Chantraine, Frédéric; Calsteren, Kristel Van; Devlieger, Roland; Gruson, Damien; Keirsbilck, Joachim Van; Garcia, Ana Dubon; Vandeweyer, Katleen; Gucciardo, Léonardo

doi:10.1016/j.preghy.2021.08.113

Cited by 7 publications

(4 citation statements)

References 37 publications

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“…From a health-economic perspective, incorporation of angiogenic factor testing has the potential to save substantial costs for the payers, primarily by reducing unnecessary hospitalizations. Similar trends have been shown for many health-care systems, primarily in high resource settings [ 35 – 37 ]. Other works on health-economic modeling have shown that in both approaches, lowering the number of women falsely labeled as having the disease and discovering additional women that would have been overlooked otherwise has the potential to reduce costs [ 9 , 38 ].…”

Section: What Are We Trying To Predict?supporting

confidence: 73%

New advances in prediction and surveillance of preeclampsia: role of machine learning approaches and remote monitoring

Hackelöer

Schmidt

Verlohren

2022

Arch Gynecol Obstet

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Preeclampsia, a multisystem disorder in pregnancy, is still one of the main causes of maternal morbidity and mortality. Due to a lack of a causative therapy, an accurate prediction of women at risk for the disease and its associated adverse outcomes is of utmost importance to tailor care. In the past two decades, there have been successful improvements in screening as well as in the prediction of the disease in high-risk women. This is due to, among other things, the introduction of biomarkers such as the sFlt-1/PlGF ratio. Recently, the traditional definition of preeclampsia has been expanded based on new insights into the pathophysiology and conclusive evidence on the ability of angiogenic biomarkers to improve detection of preeclampsia-associated maternal and fetal adverse events.However, with the widespread availability of digital solutions, such as decision support algorithms and remote monitoring devices, a chance for a further improvement of care arises. Two lines of research and application are promising: First, on the patient side, home monitoring has the potential to transform the traditional care pathway. The importance of the ability to input and access data remotely is a key learning from the COVID-19 pandemic. Second, on the physician side, machine-learning-based decision support algorithms have been shown to improve precision in clinical decision-making. The integration of signals from patient-side remote monitoring devices into predictive algorithms that power physician-side decision support tools offers a chance to further improve care.The purpose of this review is to summarize the recent advances in prediction, diagnosis and monitoring of preeclampsia and its associated adverse outcomes. We will review the potential impact of the ability to access to clinical data via remote monitoring. In the combination of advanced, machine learning-based risk calculation and remote monitoring lies an unused potential that allows for a truly patient-centered care.

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Section: What Are We Trying To Predict?supporting

confidence: 73%

New advances in prediction and surveillance of preeclampsia: role of machine learning approaches and remote monitoring

Hackelöer

Schmidt

Verlohren

2022

Arch Gynecol Obstet

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“…Such pregnancies may secrete less placental growth factor (PlGF) than normal, ultimately presenting with FGR (17,18) . By contrast, preeclampsia may increase placental weight and thickness via reactive changes in placental villi to ischemia (19) (driving up the production of several trophoblastderived proteins in maternal blood (hCG, activin and inhibin) and ultimately producing an antiangiogenic state (due to excess synthesis and secretion of the VEGF antagonist Soluble fms-like tyrosine kinase-1 (sFlt1 or sVEGFR-1) from syncytial knots (20) triggering the disease in the third trimester (21)(22)(23)(24) .…”

Section: These Results Agree With Observations Reported Bymentioning

confidence: 99%

Association of First-trimester Placental Thickness by Ultrasound and the Risk of Preeclampsia or Small Gestational Age

Alkafrawy,

Emam,

Midan

2022

SJMS

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Introduction and aim: Placenta play a crucial role in normal fetal development. Any deviation from normal could firstly affect placenta and subsequently represented on the fetus. Thus, different placental measurements could be used as predictors for complicated pregnancy. The current work was designed to examine the potential association between maximum placental thickness in the first-trimester and the subsequent risk of preeclampsia or the risk of the delivery of small for gestational age neonate Methodology: This study included 150 pregnant women with singleton pregnancy. All women were assessed by full medical history and physical examination. Clinical examination preceded the routine laboratory investigations. Finally, an ultrasound was performed and repeated each weak from 11 to 14 gestational weeks to determine crown-lump length and measure maximum placental thickness. All females were followed till delivery, with documentation of preeclampsia development and/or delivered a small for gestational age (SGA) neonate. Results: We excluded 4 women from the study due to abortion. Preeclampsia with preterm delivery recorded for 5 females, preeclampsia without preterm delivery developed in13 females, preeclampsia with SGA (5 females) and SGA among 7 females; and 116 non-complicated pregnancies. Cesarean delivery was performed for 80 females (54.8%). There was significant progressive increase of maximum placental thickness (MPT) from the 11th to the 14th weeks of gestation. Preeclampsia was associated with significant increase of MPT, while SGA was associated with significant reduction of it. The area under the curve was more than 0.7. For preeclampsia, the sensitivity was 88.89% at cutoff value > 1.0; while for SGA, the sensitivity was 100.0% at cutoff value ≤0.94. Conclusion: Maximum placental thickness at 11 to 14 weeks provides a good predictive power for development of preeclampsia and delivery of small for gestational age. This permits early therapeutic intervention.

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“…103,144 Health economic analyses across the globe reported that the incorporation of angiogenic factor testing is cost-effective. 142,[145][146][147][148][149][150][151][152][153][154][155][156][157][158] European countries have spearheaded the integration of angiogenic factor testing into clinical practice. Germany was the first to approve and implement this test more than a decade ago, 77 setting the stage for other countries to follow suit.…”

Section: Use In Clinical Practicementioning

confidence: 99%

“…Importantly, recent evidence shows that these factors also perform well in real‐world settings 103,144 . Health economic analyses across the globe reported that the incorporation of angiogenic factor testing is cost‐effective 142,145–158 …”

Section: Biomarker Studies In Preeclampsiamentioning

confidence: 99%

Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road

Thadhani,

Cerdeira,

Karumanchi

2024

The FASEB Journal

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As one of the leading causes of premature birth and maternal and infant mortality worldwide, preeclampsia remains a major unmet public health challenge. Preeclampsia and related hypertensive disorders of pregnancy are estimated to cause >75 000 maternal and 500 000 infant deaths globally each year. Because of rising rates of risk factors such as obesity, in vitro fertilization and advanced maternal age, the incidence of preeclampsia is going up with rates ranging from 5% to 10% of all pregnancies worldwide. A major discovery in the field was the realization that the clinical phenotypes related to preeclampsia, such as hypertension, proteinuria, and other adverse maternal/fetal events, are due to excess circulating soluble fms‐like tyrosine kinase‐1 (sFlt‐1, also referred to as sVEGFR‐1). sFlt‐1 is an endogenous anti‐angiogenic protein that is made by the placenta and acts by neutralizing the pro‐angiogenic proteins vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). During the last decade, this work has spawned a new era of molecular diagnostics for early detection of this condition. Antagonizing sFlt‐1 either by reducing production or blocking its actions has shown salutary effects in animal models. Further, in early‐stage human studies, the therapeutic removal of sFlt‐1 from maternal circulation has shown promise in delaying disease progression and improving outcomes. Recently, the FDA approved the first molecular test for preterm preeclampsia (sFlt‐1/PlGF ratio) for clinical use in the United States. Measuring serum sFlt‐1/PlGF ratio in the acute hospital setting may aid short‐term management, particularly regarding step‐up or step‐down of care, decision to transfer to settings better equipped to manage both the mother and the preterm neonate, appropriate timing of administration of steroids and magnesium sulfate, and in expectant management decisions. The test itself has the potential to save lives. Furthermore, the availability of a molecular test that correlates with adverse outcomes has set the stage for interventional clinical trials testing treatments for this disorder. In this review, we will discuss the role of circulating sFlt‐1 and related factors in the pathogenesis of preeclampsia and specifically how this discovery is leading to concrete advances in the care of women with preeclampsia.

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Enhancing the value of the sFlt-1/PlGF ratio for the prediction of preeclampsia: Cost analysis from the Belgian healthcare payers’ perspective

Cited by 7 publications

References 37 publications

New advances in prediction and surveillance of preeclampsia: role of machine learning approaches and remote monitoring

New advances in prediction and surveillance of preeclampsia: role of machine learning approaches and remote monitoring

Association of First-trimester Placental Thickness by Ultrasound and the Risk of Preeclampsia or Small Gestational Age

Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road

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