sFlt-1PlGF Ratio as a Predictive Marker in Women with Suspected Preeclampsia: An Economic Evaluation from a Swiss Perspective

الملخص EN

In Switzerland, 2.3% of pregnant women develop preeclampsia.

Quantification of the soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) ratio has shown a diagnostic value in the second and third trimesters of pregnancy, in particular in ruling out preeclampsia within one week.

We estimated the economic impact of implementing sFlt-1/PlGF ratio evaluation, in addition to the standard of care (SOC), for women with suspected preeclampsia from a Swiss healthcare system’s perspective.

A decision tree model was developed to estimate direct medical costs of diagnosis and management of a simulated cohort of Swiss pregnant women with suspected preeclampsia (median week of gestation: 32) until delivery.

The model compared SOC vs.

SOC plus sFlt-1/PlGF ratio, using clinical inputs from a large multicenter study (PROGNOSIS).

Resource use data and unit costs were obtained from hospital records and public sources.

The assumed cost for sFlt-1/PlGF evaluation was €141.

Input parameters were validated by clinical experts in Switzerland.

The model utilized a simulated cohort of 6084 pregnant women with suspected preeclampsia (representing 7% of all births in Switzerland in 2015, n=86,919).

In a SOC scenario, 36% of women were hospitalized, of whom 27% developed preeclampsia and remained hospitalized until birth.

In a sFlt-1/PlGF test scenario, 76% of women had a sFlt-1/PlGF ratio of ≤38 (2% hospitalized), 11% had a sFlt-1/PlGF ratio of >38-<85 (55% hospitalized), and 13% had a sFlt-1/PlGF ratio of ≥85 (65% hospitalized).

Total average costs/pregnant woman (including birth) were €10,925 vs.

€10,579 (sFlt-1/PlGF), and total costs were €66,469,362 vs.

€64,363,060 (sFlt-1/PlGF).

Implementation of sFlt-1/PlGF evaluation would potentially achieve annual savings of €2,105,064 (€346/patient), mainly due to reduction in unnecessary hospitalization.

sFlt-1/PlGF evaluation appears economically promising in predicting short-term absence of preeclampsia in Swiss practice.

Improved diagnostic accuracy and reduction in unnecessary hospitalization could lead to significant cost savings in the Swiss healthcare system.