Impact of sFlt-1/PlGF Ratio Testing for Early Preeclampsia Detection on Healthcare Resource Utilization in Routine Pregnancy Management

OBJECTIVES: Preeclampsia (PE) is a severe complication affecting 2-8% of pregnancies. Using the sFlt-1/PlGF ratio test starting from the 24th week of pregnancy has shown high diagnostic and predictive value for the onset of PE. This study aims to assess the impact of incorporating this test in routine pregnancy management on healthcare resource utilization (HCRU).

METHODS: The study compared pregnancy management strategies without the sFlt-1/PlGF ratio testing to those with testing of women with high risk of PE. The research hypothesis suggested that expanding the practice of this testing for early diagnosis of PE might optimize HCRU due to its superiority in specificity over no testing strategy. We developed a decision tree model using test sensitivity and specificity data from the PROGNOSIS trial, along with statistical data on the number of pregnancies, PE severity, and the average number of tests per pregnancy. The model categorizes pregnant women into risk groups with different management strategies, including standard and enhanced monitoring, inpatient hospitalization (corresponding HCRU rates were defined by the panel board). The model was validated on data from three Russian regions.

RESULTS: Upon validating the model with data from 70,162 pregnancies (with a PE frequency of 34.4 cases per 1,000 births), it is expected that with no tests among women at high risk of PE, there will be 5,198 inpatient hospitalizations (IHs), 2,715 day hospital care (DHR), and 27,167 additional outpatient visits (OV). With the implementation of one test per pregnancy, the number of IHs would decrease to 3,309, DHRs to 671, and additional OVs to 19,463. With two tests per pregnancy, HCRU would still be lower than in current practice: IHs would be 4,917, DHRs – 1,419, and additional OVs – 27,644.

CONCLUSIONS: Implementing routine sFlt-1/PlGF ratio testing in pregnancy management can enhance the diagnosis of PE, potentially reducing HCRU.