英国早产子痫前期孕早期筛查的成本效益分析

原文

ABSTRACT Objective To evaluate the cost-effectiveness of the Fetal Medicine Foundation (FMF) strategy, compared with the National Institute for Health and Care Excellence (NICE) strategy, for first-trimester screening for preterm preeclampsia (PE) in the United Kingdom (UK). Design Cost-effectiveness analysis. Setting UK National Health Service and personal social services perspective. Population A total of 10 000 simulated patients with singleton pregnancies at 11–13 weeks' gestation, across a lifetime time horizon. Methods A decision-tree model was developed to perform a cost-effectiveness analysis. In the base-case analysis, NICE-recommended screening was compared with FMF screening, using maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF). The model assumed that patients identified as high-risk for PE were prescribed 150 mg aspirin daily until 36 weeks' gestation. Scenario analyses varied PE incidence, aspirin adherence and biomarker combinations of FMF strategy components. Main Outcome Measure Incremental cost-effectiveness ratios (ICERs) were calculated using incremental costs and quality-adjusted life years (QALYs). Dominant ICERs demonstrated lower costs and higher QALYs. Results Compared with NICE-recommended screening, the FMF strategy demonstrated a cost-saving of £3191 and QALY gain of 0.92 per 10 000 patients (dominant ICER), with a cost-saving of £199 per preterm PE case avoided. In scenario analyses, the FMF strategy was cost-effective across 3%, 5% and 7% PE incidence, and 75% and 100% aspirin adherence. The base-case FMF strategy (maternal factors + MAP + UtA-PI + PlGF) was the most clinically effective option. Conclusions The FMF strategy was more cost-effective versus the NICE strategy for first-trimester preterm PE screening in the UK.