Gert-Jan van Baaren1, Wietske Hermes2, Arie Franx3, Maria G van Pampus4, Kitty W M Bloemenkamp5, Joris A van der Post6, Martina Porath7, Gabrielle A E Ponjee8, Jouke T Tamsma9, Ben Willem J Mol10, Brent C Opmeer11, Christianne J M de Groot12. 1. Department of Obstetrics and Gynecology, Academic Medical Center, 1105 DE Amsterdam, The Netherlands. Electronic address: g.j.vanbaaren@amc.uva.nl. 2. Department of Obstetrics and Gynecology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA The Hague, The Netherlands. Electronic address: herwie@mchaaglanden.nl. 3. Department of Obstetrics and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address: a.franx-2@umcutrecht.nl. 4. Department of Obstetrics and Gynecology, The Onze Lieve Vrouwe Gasthuis (OLVG) Hospital, Oosterpark 9, 1091 AC Amsterdam, The Netherlands. Electronic address: m.g.vanpampus@olvg.nl. 5. Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: k.w.m.bloemenkamp@lumc.nl. 6. Department of Obstetrics and Gynecology, Academic Medical Center, 1105 DE Amsterdam, The Netherlands. Electronic address: j.a.vanderpost@amc.uva.nl. 7. Department of Obstetrics and Gynecology, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands. Electronic address: m.porath@mmc.nl. 8. Department of Clinical Chemistry, Medical Center Haaglanden, Lijnbaan 32, 2512 VA The Hague, The Netherlands. Electronic address: g.ponjee@mchaaglanden.nl. 9. Section of Vascular Medicine, Department of Endocrinology and Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: j.t.tamsma@lumc.nl. 10. Department of Obstetrics and Gynecology, The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia. Electronic address: ben.mol@adelaide.edu.au. 11. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, 1105 DE Amsterdam, The Netherlands. Electronic address: b.c.opmeer@amc.uva.nl. 12. Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: cdegroot@me.com.
Abstract
OBJECTIVES: To assess the cost-effectiveness of post-partum screening on cardiovascular risk factors and subsequent treatment in women with a history of gestational hypertension or pre-eclampsia at term. STUDY DESIGN: Two separate Markov models evaluated the cost-effectiveness analysis of hypertension (HT) screening and screening on metabolic syndrome (MetS), respectively, as compared to current practice in women with a history of term hypertensive pregnancy disorders. Analyses were performed from the Dutch health care perspective, using a lifetime horizon. One-way sensitivity analyses and Monte Carlo simulation evaluated the robustness of the results. RESULTS: Both screening on HT and MetS in women with a history of gestational hypertension or pre-eclampsia resulted in increase in life expectancy (HT screening 0.23year (95% CI -0.06 to 0.54); MetS screening 0.14years (95% CI -0.16 to 0.45)). The gain in QALYs was limited, with HT screening and MetS screening generating 0.04 QALYs (95% CI -0.12 to 0.20) and 0.03 QALYs (95% CI -0.14 to 0.19), resulting in costs to gain one QALY of €4228 and €28,148, respectively. Analyses for uncertainty showed a chance of 74% and 75%, respectively, that post-partum screening is cost-effective at a threshold of €60,000/QALY. CONCLUSIONS: According to the available knowledge post-partum screening on cardiovascular risk factors and subsequent treatment in women with a history of gestational hypertension or pre-eclampsia at term is likely to be cost-effective.
OBJECTIVES: To assess the cost-effectiveness of post-partum screening on cardiovascular risk factors and subsequent treatment in women with a history of gestational hypertension or pre-eclampsia at term. STUDY DESIGN: Two separate Markov models evaluated the cost-effectiveness analysis of hypertension (HT) screening and screening on metabolic syndrome (MetS), respectively, as compared to current practice in women with a history of term hypertensive pregnancy disorders. Analyses were performed from the Dutch health care perspective, using a lifetime horizon. One-way sensitivity analyses and Monte Carlo simulation evaluated the robustness of the results. RESULTS: Both screening on HT and MetS in women with a history of gestational hypertension or pre-eclampsia resulted in increase in life expectancy (HT screening 0.23year (95% CI -0.06 to 0.54); MetS screening 0.14years (95% CI -0.16 to 0.45)). The gain in QALYs was limited, with HT screening and MetS screening generating 0.04 QALYs (95% CI -0.12 to 0.20) and 0.03 QALYs (95% CI -0.14 to 0.19), resulting in costs to gain one QALY of €4228 and €28,148, respectively. Analyses for uncertainty showed a chance of 74% and 75%, respectively, that post-partum screening is cost-effective at a threshold of €60,000/QALY. CONCLUSIONS: According to the available knowledge post-partum screening on cardiovascular risk factors and subsequent treatment in women with a history of gestational hypertension or pre-eclampsia at term is likely to be cost-effective.