Presentation (CTI)

OBJECTIVES: Preeclampsia is a major cause of maternal and neonatal morbidity worldwide, with the greatest burden in low- and middle-income countries (LMICs) where diagnostic uncertainty leads to avoidable preterm deliveries. Although the sFlt-1/PlGF biomarker is widely available in high-income settings, access remains limited in LMICs. This economic evaluation examined whether introducing this test could reduce unnecessary early deliveries, improve neonatal outcomes, and strengthen system efficiency across diverse LMIC health systems.
METHODS: Ten countries with the highest maternal hypertensive disorder incidence were selected: six upper-middle-income (Indonesia, China, Brazil, Mexico, Colombia, Türkiye) and four low/lower-middle-income (India, Nigeria, Ethiopia, Democratic Republic of the Congo). A decision model estimated neonatal and cost outcomes from reducing iatrogenic preterm deliveries. Biologic inputs (delivery probability by gestational age and neonatal severity) leveraged US and EU studies due to strong cross-population transferability. In contrast, gestational-age distributions used 2023 UN-agency estimates, and NICU costs used national and WHO-CHOICE data. Care-guidance impact was scaled 50-100 percent using an innovative calibration approach for cross-country transferability.
RESULTS: Across all settings, modeling showed a 17-22% reduction in births before 34 weeks, leading to lower neonatal mortality and morbidity. In all upper-middle-income countries and India, testing generated net cost savings of approximately USD 160-700 per hospitalized woman with suspected preeclampsia. Cost savings persisted when care-guidance impact, the extent to which results changed delivery decisions, was reduced to 50 percent. In lower-income settings, avoided neonatal harm from prematurity was the dominant benefit, smaller direct cost offsets were due to limited NICU capacity and lower expenditure baselines.
CONCLUSIONS: sFlt-1/PlGF testing could strengthen maternal-neonatal systems in LMICs by reducing preterm births and improving newborn outcomes. In upper-middle-income settings, health and cost benefits support value-based adoption. In lower-income contexts, findings inform global and philanthropic efforts to expand equitable access. This analysis shows how economic evaluation can guide system-level decisions in maternal health.