Is implementing a national preeclampsia screening program worth it?
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Osakidetza, UPV/EHU, Spain
Osteba, Spain
OSTEBA - Basque Office for Health Technology Assessment, Spain
Osakidetza, Biocruces
Osakidetza, Biocruces, Spain
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1765
Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria in the last half of pregnancy or postpartum. Due to the high risk for the mother and also the child it would be really useful to detect as early as possible if a woman is at high risk of developing preeclampsia or not. Nowadays the risk is assessed evaluating determined risk factors from clinical records which has a limited precision. In some places are developing a "combined preeclampsia screening" that uses medical records plus other factors such as biomarkers like placental growth factor, pregnancy associated plasma protein-A or uterine arteries pulsatility index. Our objective is to evaluate security, efficiency an efficacy of preeclampsia screening programs on pregnant women. To evaluate efficacy and security of screening programs based on predictive models and low dose aspirin for preeclampsia prevention we made a revision of systematic reviews from the latest scientific evidence available. To analyze the cost-effectivity of screening programs based on predictive models and low dose aspirin on women at high risk of developing preeclampsia versus common practice we made research on economic evaluations available. All selected articles were evaluated following AMSTAR-2 criteria. As results, we found that the first trimester models where biophysics and biochemical markers plus maternal characteristics were used, presented the best detection rate for early preeclampsia. We also found that the use of aspirin decreased between 15%-18% preeclampsia risk being statistically significative achieving a greater reduction when given to a high number of nulliparous women. To conclude, according to the evidence found, preeclampsia screening in first trimester based on Fetal Medicine Foundation algorithm plus low dose aspirin treatment in women at high risk of preeclampsia was more effective, prevented preeclampsia cases and was cheaper than costs related with preeclampsia´s clinical management.
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