OBJECTIVES: To analyse the economic and resource implications of using plasma soluble fms-like tyrosine kinase-1 s(Flt1) and placenta growth factor (PlGF) measurements in pre-eclampsia evaluation and management. DESIGN: Retrospective cost analysis of our prospective cohort study. SETTING: Boston, Massachusetts (USA). POPULATION: Women (n = 176) presenting to the hospital at <34 weeks of gestation for evaluation of possible pre-eclampsia during 2009-10. Cases without complete cost or outcome data (n = 9) and re-enrolments (n = 18) were excluded. METHODS: Modelled comparisons between the standard approach (combination of blood pressure, urinary protein excretion, alanine aminotransferase and platelet counts) and a novel approach (ratio of plasma sFlt1 and PlGF) using actual hospital data converted to 2012 US dollars in accordance with the Centers for Medicare and Medicaid Services. MAIN OUTCOME MEASURES: Direct 2-week costs and resource use by groups having true or false positive and negative test results for adverse outcomes according to approach. RESULTS: The improved specificity of the novel approach decreased the proportion of women falsely labelled as test-positive from 42.3% (34.4-50.2%) to 4.0% (0.85-7.15%) and increased the proportion correctly labelled as test-negative from 23.5% (16.7-30.3%) to 61.7% (53.9-69.5%). This could potentially reduce average per-patient costs by $1215. Substantial quantities of resources [47.2% (35.7-58.7%) of antenatal admissions and 72.5% (68.0-77.0%) of tests for fetal wellbeing] were unnecessarily used for women who were truly negative. A proportion of iatrogenic preterm deliveries among women with negative results was potentially avoidable representing further cost and resource savings. CONCLUSIONS: Clinical use of the plasma sFlt1 and PlGF ratio improves risk stratification among women presenting for pre-eclampsia evaluation and has the potential to reduce costs and resource use.
OBJECTIVES: To analyse the economic and resource implications of using plasma soluble fms-like tyrosine kinase-1 s(Flt1) and placenta growth factor (PlGF) measurements in pre-eclampsia evaluation and management. DESIGN: Retrospective cost analysis of our prospective cohort study. SETTING: Boston, Massachusetts (USA). POPULATION: Women (n = 176) presenting to the hospital at <34 weeks of gestation for evaluation of possible pre-eclampsia during 2009-10. Cases without complete cost or outcome data (n = 9) and re-enrolments (n = 18) were excluded. METHODS: Modelled comparisons between the standard approach (combination of blood pressure, urinary protein excretion, alanine aminotransferase and platelet counts) and a novel approach (ratio of plasma sFlt1 and PlGF) using actual hospital data converted to 2012 US dollars in accordance with the Centers for Medicare and Medicaid Services. MAIN OUTCOME MEASURES: Direct 2-week costs and resource use by groups having true or false positive and negative test results for adverse outcomes according to approach. RESULTS: The improved specificity of the novel approach decreased the proportion of women falsely labelled as test-positive from 42.3% (34.4-50.2%) to 4.0% (0.85-7.15%) and increased the proportion correctly labelled as test-negative from 23.5% (16.7-30.3%) to 61.7% (53.9-69.5%). This could potentially reduce average per-patient costs by $1215. Substantial quantities of resources [47.2% (35.7-58.7%) of antenatal admissions and 72.5% (68.0-77.0%) of tests for fetal wellbeing] were unnecessarily used for women who were truly negative. A proportion of iatrogenic preterm deliveries among women with negative results was potentially avoidable representing further cost and resource savings. CONCLUSIONS: Clinical use of the plasma sFlt1 and PlGF ratio improves risk stratification among women presenting for pre-eclampsia evaluation and has the potential to reduce costs and resource use.
Authors: Josephine A Mauskopf; Sean D Sullivan; Lieven Annemans; Jaime Caro; C Daniel Mullins; Mark Nuijten; Ewa Orlewska; John Watkins; Paul Trueman Journal: Value Health Date: 2007 Sep-Oct Impact factor: 5.725
Authors: Tinnakorn Chaiworapongsa; Roberto Romero; Yeon Mee Kim; Gi Jin Kim; Mi Ran Kim; Jimmy Espinoza; Emmanuel Bujold; Luís Gonçalves; Ricardo Gomez; Samuel Edwin; Moshe Mazor Journal: J Matern Fetal Neonatal Med Date: 2005-01
Authors: Sharon E Maynard; Jiang-Yong Min; Jaime Merchan; Kee-Hak Lim; Jianyi Li; Susanta Mondal; Towia A Libermann; James P Morgan; Frank W Sellke; Isaac E Stillman; Franklin H Epstein; Vikas P Sukhatme; S Ananth Karumanchi Journal: J Clin Invest Date: 2003-03 Impact factor: 14.808
Authors: C A Meads; J S Cnossen; S Meher; A Juarez-Garcia; G ter Riet; L Duley; T E Roberts; B W Mol; J A van der Post; M M Leeflang; P M Barton; C J Hyde; J K Gupta; K S Khan Journal: Health Technol Assess Date: 2008-03 Impact factor: 4.014
Authors: Stefan Verlohren; Alberto Galindo; Dietmar Schlembach; Harald Zeisler; Ignacio Herraiz; Manfred G Moertl; Juliane Pape; Joachim W Dudenhausen; Barbara Denk; Holger Stepan Journal: Am J Obstet Gynecol Date: 2009-10-21 Impact factor: 8.661
Authors: Andreea G Moore; Heather Young; Jennifer M Keller; Linda R Ojo; Jing Yan; Tiffany A Moore Simas; Sharon E Maynard Journal: J Matern Fetal Neonatal Med Date: 2012-08-22
Authors: Liona C Poon; Laura A Magee; Stefan Verlohren; Andrew Shennan; Peter von Dadelszen; Eyal Sheiner; Eran Hadar; Gerard Visser; Fabricio Da Silva Costa; Anil Kapur; Fionnuala McAuliffe; Amala Nazareth; Muna Tahlak; Anne B Kihara; Hema Divakar; H David McIntyre; Vincenzo Berghella; Huixia Yang; Roberto Romero; Kypros H Nicolaides; Nir Melamed; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2021-07 Impact factor: 4.447
Authors: Glenn E Palomaki; James E Haddow; Hamish R M Haddow; Saira Salahuddin; Carl Geahchan; Ana Sofia Cerdeira; Stefan Verlohren; Frank H Perschel; Gary Horowitz; Ravi Thadhani; S Ananth Karumanchi; Sarosh Rana Journal: Prenat Diagn Date: 2015-02-04 Impact factor: 3.050
Authors: Suzy Duckworth; Lucy C Chappell; Paul T Seed; Lucy Mackillop; Andrew H Shennan; Rachael Hunter Journal: PLoS One Date: 2016-10-14 Impact factor: 3.240
Authors: Ignacio Herraiz; Elisa Simón; Paula Isabel Gómez-Arriaga; José Manuel Martínez-Moratalla; Antonio García-Burguillo; Elena Ana López Jiménez; Alberto Galindo Journal: Int J Mol Sci Date: 2015-08-13 Impact factor: 5.923