Placental growth factor testing for suspected pre‐eclampsia: a cost‐effectiveness analysis

Abstract

Objective To calculate the cost‐effectiveness of implementing PlGF testing alongside a clinical management algorithm in maternity services in the UK, compared with current standard care. Design Cost‐effectiveness analysis. Setting Eleven maternity units participating in the PARROT stepped‐wedge cluster‐randomised controlled trial. Population Women presenting with suspected pre‐eclampsia between 20+0 and 36+6 weeks’ gestation. Methods Monte Carlo simulation utilising resource use data and maternal adverse outcomes. Main outcome measures Cost per maternal adverse outcome prevented. Results Clinical care with PlGF testing costs less than current standard practice and resulted in fewer maternal adverse outcomes. There is a total cost‐saving of UK£149 per patient tested, when including the cost of the test. This represents a potential cost‐saving of UK£2,891,196 each year across the NHS in England. Conclusions Clinical care with PlGF testing is associated with the potential for cost‐savings per participant tested when compared with current practice via a reduction in outpatient attendances, and improves maternal outcomes. This economic analysis supports a role for implementation of PlGF testing in antenatal services for the assessment of women with suspected pre‐eclampsia. Tweetable abstract Placental growth factor testing for suspected pre‐eclampsia is cost‐saving and improves maternal outcomes.

Updates in Diagnosis and Management of Preeclampsia in Women with CKD

“…Although this cohort included 287 women, of which 19 (7%) had CKD, median and interquartile ranges for serum creatinine were 0.58 mg/dl and 0.50-0.70 mg/dl, respectively. More recently, a randomized controlled trial of revealed versus concealed PlGF testing was shown to reduce the time to diagnosis and maternal adverse event rate, with no difference in perinatal outcomes (19), at a cost saving of £149 ($190) per patient compared with usual surveillance, including the test cost of £70 ($90) (21). Only 4% of women in this trial had CKD.…”

Placental growth factor measurements in the assessment of women with suspected Preeclampsia: A stratified analysis of the PARROT trial

“…Our cost effectiveness analysis has been previously reported. The resource use data showed that PlGF was overall cost saving, with an increase in antenatal inpatient costs for those with abnormal PlGF alongside a reduction in outpatient attendances in those with a normal result, suggesting improved risk stratification with PlGF testing [24] . As we did not undertake a more detailed process evaluation, the exact components of changes in the antenatal care pathways that contributed to the reduction in severe maternal adverse outcomes may remain unclear.…”

Placental growth factor in suspected preterm pre‐eclampsia: a review of the evidence and practicalities of implementation

“…Initial studies using economic modelling demonstrated that PlGF‐based testing may afford a cost saving of between UK£330 and UK£1,032 per woman tested 17,18 . In a more recent study describing their cost‐effectiveness analysis of the PARROT trial, Duhig and colleagues found a total cost saving of UK£149 per woman, based on UK£70 per Triage PlGF test 19 . Given that there were 646 794 births in England in 2017 and 10% of pregnant women have suspected pre‐eclampsia, with 30% of these presenting prior to 37 weeks' gestation, PlGF testing could be performed in approximately 38 800 women per year.…”

“…The cost‐saving seen in this budget impact analysis is more conservative than previous hypothetical savings. The authors conclude that this may be due to improved clinical risk stratification, leading to appropriate redistribution of resources, rather than an overall reduction of resource use 19 …”