Economic aspects of introducing tests for early diagnosis of preeclampsia into the routine practice of managing pregnancy

Preeclampsia is one of the most serious pregnancy complications affecting 2-8% of pregnancies. In the last decade, it has become possible to detect preeclampsia early by determining the ratio of angiogenic factors sFlt-1/PlGF; thus, the incidence of maternal and perinatal complications may be reduced.

Objective: To assess the impact of introducing the sFlt-1/PlGF ratio for early diagnosis of preeclampsia into the routine practice of managing pregnancy on clinical outcomes and health care system costs in the Russian Federation.

Materials and methods: The study was based on a mathematical model to determine the ratio of angiogenic factors sFlt-1/PlGF in all pregnant women at high risk of preeclampsia; these factors were determined by first trimester screening. The initial data for building the model were the results of the PROGNOSIS clinical trial, statistical materials and a survey of experts. The early detection of preeclampsia was expected to contribute to the improvement of pregnancy management tactics and reduce the health care costs, including preventive care, emergency and planned hospitalizations, and treatment of pregnancy complications. The developed model was tested in the Moscow region, the Samara region and the Republic of Bashkortostan.

Results: The introduction of testing into the routine practice of managing pregnancy may reduce the incidence of life-threatening complications for the pregnant woman (severe preeclampsia, HELLP syndrome) and fetus/newborn (stillbirth, perinatal mortality, respiratory distress syndrome, periventricular leukomalacia). Due to the decrease in the number of cases of providing medical care for patients who do not develop preeclampsia (misdiagnosed without a test), as well as the decrease in the number of emergency hospitalizations and deliveries for patients who have preeclampsia outside the hospital (in the absence of timely diagnosis), the total costs of the Obligatory Medical Insurance system will not increase if the average number of tests is 1.45 or less per pregnant woman with a high risk of developing preeclampsia.

Conclusion: The introduction of the sFlt-1/PlGF ratio into the routine practice of managing patients at high risk for preeclampsia has the potential to reduce adverse pregnancy outcomes and the cost of managing pregnancy.