Economic assessment of preeclampsia:Screening, diagnosis, treatment options, and long term outcomes - A systematic review

OBJECTIVES: Provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis, and treatment options in preeclampsia.METHODS: A systematic literature search was undertaken using three electronic databases (MEDLINE, Embase, Cochrane) to identify all English language full papers published between 1994 and 2014 containing economic evaluation or budget impact analysis (BIA) studies concerning the screening, diagnosis, treatment and prevention of preeclampsia. In addition, the included studies were appraised by means of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement for economic evaluations and the guidelines on reporting format for budget impact analysis (ISPOR Principles of Good practice for Budget Impact Analysis) for BIA studies.RESULTS: From an initial total of 119 citations, six papers fulfilled the eligibility criteria, five of which were economic evaluations and one was a BIA. All studies were published between 2001 and 2012. One study was on early screening using maternal markers, and concluded that this may be cost-effective from a payer perspective. Three other studies focused on treatment and management, and concluded that induction of delivery is the most cost-effective option in term preeclampsia. Also, magnesium sulfate was found to be a cost-effective treatment, but more so in low income countries. One study was a comprehensive HTA report on combination strategies of screening and prevention, which found that providing calcium to all pregnant women without prior testing was the most cost-effective strategy. The BIA, on introducing a novel diagnostic test, concluded that the savings associated with this test would offset its initial cost.CONCLUSIONS: Novel biomarkers in screening for and diagnosing preeclampsia show promise as a cost-effective approach, from a payer perspective. Moreover, magnesium sulfate seemed to be a cost-effective option to manage seizures in preeclamptic women while delivery remains the ultimate efficient treatment, especially for women with term preeclampsia.DISCLOSURES: N. Zakiyah: None. A.D. van Asselt: None. P.N. Baker: minority shareholder Metabolomic Diagnostics, a small biotech company seeking to develop screening tests for pre-eclampsia. M.J. Postma: Advisor, Commercial Interest: SHIRE, GSK, Roche, Boehringer Ingelheim, Pfizer, SPMSD.