First-Trimester Screening for Preterm Pre-Eclampsia in the United Kingdom: A Cost-Effectiveness Analysis
Author(s)
Mohammed Ali Ani, MSc1, Chiu Yee Liona Poon, PhD2, Joy Allen, PhD1, Kh Nicolaides, MD3.
1Roche Diagnostics Limited, Burgess Hill, United Kingdom, 2The Chinese University of Hong Kong, Hong Kong, China, 3Fetal Medicine, King’s College hospital, London, United Kingdom.
1Roche Diagnostics Limited, Burgess Hill, United Kingdom, 2The Chinese University of Hong Kong, Hong Kong, China, 3Fetal Medicine, King’s College hospital, London, United Kingdom.
OBJECTIVES: Pre-eclampsia (PE) is a serious pregnancy complication, making early identification essential for initiating risk-reduction strategies such as low-dose aspirin prophylaxis. UK NICE guideline NG133 recommends first-trimester risk assessment using maternal factors (MF) and blood pressure, but this has limited predictive performance. The Fetal Medicine Foundation (FMF) algorithm, incorporating MF, mean arterial pressure (MAP), uterine artery Doppler (UtA-PI), and placental growth factor (PlGF), is an alternative screening algorithm which has shown improved accuracy. This study evaluates the cost-effectiveness of the FMF algorithm compared with the NICE strategy for first-trimester screening of pre-term PE in the UK.
METHODS: A decision-tree model-based cost-utility analysis was developed from the UK National Health Service (NHS) perspective. A cohort of 10,000 singleton pregnancies between 11-13 weeks’ gestation was simulated over a one-year horizon. The model incorporated screening, treatment, delivery, and neonatal outcomes, with associated costs and utilities derived from published sources and expert opinion. Uncertainty was explored through scenario and sensitivity analyses.
RESULTS: Results for the base case analysis demonstrate that FMF was associated with lower costs and higher Quality Adjusted Life Years (QALYs) compared to the NICE strategy, resulting in a dominant incremental cost-effectiveness ratio (ICER). The base case demonstrated that FMF avoided 16 additional pre-term PE cases (23%) compared to the NICE strategy per 10,000 screened. FMF remained the dominant strategy across several key scenario analyses, including variations in PE incidence, aspirin adherence, and test combinations, only losing cost-effectiveness at very low aspirin adherence (25% and 50%). The results of the probabilistic sensitivity analysis were consistent with the base-case.
CONCLUSIONS: This study demonstrates that first-trimester screening with FMF is cost-effective compared to the current NICE strategy, primarily due to better detection and prevention of pre-term PE. These findings could support improved clinical decision-making and inform policy for PE screening in the UK.
METHODS: A decision-tree model-based cost-utility analysis was developed from the UK National Health Service (NHS) perspective. A cohort of 10,000 singleton pregnancies between 11-13 weeks’ gestation was simulated over a one-year horizon. The model incorporated screening, treatment, delivery, and neonatal outcomes, with associated costs and utilities derived from published sources and expert opinion. Uncertainty was explored through scenario and sensitivity analyses.
RESULTS: Results for the base case analysis demonstrate that FMF was associated with lower costs and higher Quality Adjusted Life Years (QALYs) compared to the NICE strategy, resulting in a dominant incremental cost-effectiveness ratio (ICER). The base case demonstrated that FMF avoided 16 additional pre-term PE cases (23%) compared to the NICE strategy per 10,000 screened. FMF remained the dominant strategy across several key scenario analyses, including variations in PE incidence, aspirin adherence, and test combinations, only losing cost-effectiveness at very low aspirin adherence (25% and 50%). The results of the probabilistic sensitivity analysis were consistent with the base-case.
CONCLUSIONS: This study demonstrates that first-trimester screening with FMF is cost-effective compared to the current NICE strategy, primarily due to better detection and prevention of pre-term PE. These findings could support improved clinical decision-making and inform policy for PE screening in the UK.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE474
Topic
Economic Evaluation
Disease
Reproductive & Sexual Health