Strategies for Prescribing Aspirin to Prevent Preeclampsia A Cost-Effectiveness Analysis
Strategies for Prescribing Aspirin to Prevent Preeclampsia A Cost-Effectiveness Analysis
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DOI：
10.1097/aog.0000000000003413
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发表时间：
2019-09-01
影响因子：
7.2
通讯作者：
Werner, Erika F.
中科院分区：
文献类型：
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作者：
Mallampati, Divya;Grobman, William;Werner, Erika F.
目的：评估各种先兆子痫筛查和阿司匹林预防策略的成本效益，包括基于生物标志物和超声测量的策略。方法：我们设计了一项决策分析，以比较妊娠 16 周前开始使用阿司匹林预防先兆子痫的四种妊娠期策略的先兆子痫相关成本和效果。这四种策略是：1）不使用阿司匹林，2）生物标志物和超声测量预测使用，3）根据美国预防服务工作组指南使用，4）普遍使用阿司匹林。我们的结果是先兆子痫相关的费用和每 100,000 名孕妇的病例数。使用每例先兆子痫 90,843 美元的阈值，进行单向、双向和蒙特卡罗敏感性分析，纳入因使用阿司匹林、阿司匹林相关副作用和成本而导致的风险降低的不同概率，以确定阿司匹林相关并发症的成本和风险改变首选策略的范围。 结果：与通用阿司匹林给药相比，美国预防服务工作组指南的使用与每 100,000 名孕妇的医疗保健费用增加 8,011,725 美元，子痫前期病例增加 346 例；生物标志物和超声筛查与额外的 19,216,551 美元和 308 例额外病例相关。同样，不使用阿司匹林与增加 18,750,381 美元的费用和增加 762 例病例无关。因此，普遍使用阿司匹林主导了所有其他三种策略。在对 10,000 名孕妇进行的蒙特卡罗模拟中，91% 的模拟中通用阿司匹林是首选策略。在 8.5% 的模拟中首选美国预防工作组筛查，在 0% 和 0.5% 的模拟中首选生物标志物和超声筛查以及不服用阿司匹林。结论：在广泛的假设范围内，相对于不服用阿司匹林和基于血清和超声测量或临床危险因素服用阿司匹林，普遍服用阿司匹林与较少的先兆子痫病例和较低的成本相关。
OBJECTIVE: To evaluate the cost effectiveness of various preeclampsia screening and aspirin prophylaxis strategies, including a strategy based on biomarker and ultrasound measures.METHODS: We designed a decision analysis to compare preeclampsia-related costs and effects of four strategies for aspirin use in pregnancy initiated before 16 weeks of gestation to prevent preeclampsia. The four strategies were: 1) no aspirin use, 2) biomarker and ultrasound measure-predicated use, 3) use based on the U.S. Preventive Services Task Force guidelines, and 4) universal aspirin use. Our outcomes were preeclampsia-related costs and number of cases per 100,000 pregnant women. Using a threshold of $90,843 per case of preeclampsia, one-way, two-way, and Monte-Carlo sensitivity analyses incorporating varying probabilities of risk reduction due to aspirin use, aspirin-related side effects, and costs were performed to identify ranges at which costs and risks of aspirin-related complications shifted the preferred strategy.RESULTS: Compared with universal aspirin administration, the use of U.S. Preventive Services Task Force guidelines is associated with $8,011,725 higher health care costs and 346 additional cases of preeclampsia per 100,000 pregnant women; biomarker and ultrasound screening is associated with an additional $19,216,551 and 308 additional cases. Similarly, no aspirin use is associated with an increased cost of $18,750,381 and 762 additional cases. Thus, universal aspirin use dominated all three other strategies. In a Monte Carlo simulation of 10,000 pregnant women, universal aspirin was the preferred strategy in 91% of simulations. The U.S. Preventive Task Force screen was preferred in 8.5% of simulations, and biomarker and ultrasound screening and no aspirin were preferred in 0% and 0.5% of simulations, respectively.CONCLUSION: Over a broad range of assumptions, universal aspirin administration is associated with fewer cases of preeclampsia and fewer costs relative to no aspirin administration and aspirin administration based on serum and ultrasound measures or clinical risk factors.