title: Cost and resource implications with serum angiogenic factor estimation in the triage of pre-eclampsia.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective cost analysis of our prospective cohort study.
  
  
  METHODS
  Boston, Massachusetts (USA).
  
  
  METHODS
  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.
  
  
  METHODS
  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: Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: W T
authors: WT
authors: Schnettler
authors: D
authors: D
authors: Dukhovny
authors: J
authors: J
authors: Wenger
authors: S
authors: S
authors: Salahuddin
authors: S J
authors: SJ
authors: Ralston
authors: S
authors: S
authors: Rana
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003365:Costs and Cost Analysis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis / Q000191:economics; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood / Q000191:economics*; D012189:Retrospective Studies; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood / Q000191:economics*
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: Angiogenic factors; costs; pre-eclampsia; resource use
references: Am J Obstet Gynecol. 2010 Feb;202(2):161.e1-161.e11
references: 19850276
references: Z Geburtshilfe Neonatol. 2010 Dec;214(6):234-8
references: 21207323
references: J Matern Fetal Neonatal Med. 2012 Dec;25(12):2651-7
references: 22861812
references: Circulation. 2012 Feb 21;125(7):911-9
references: 22261192
references: Am J Obstet Gynecol. 2009 May;200(5):481.e1-7
references: 19019323
references: J Matern Fetal Neonatal Med. 2009 Nov;22(11):1021-38
references: 19900040
references: Value Health. 2007 Sep-Oct;10(5):336-47
references: 17888098
references: MMWR CDC Surveill Summ. 1997 Aug 8;46(4):17-36
references: 9259215
references: Am J Obstet Gynecol. 2012 Nov;207(5):407.e1-7
references: 22981320
references: J Matern Fetal Neonatal Med. 2011 Oct;24(10):1187-207
references: 21827221
references: N Engl J Med. 2004 Feb 12;350(7):672-83
references: 14764923
references: Semin Perinatol. 2009 Jun;33(3):130-7
references: 19464502
references: BJOG. 2012 Jun;119(7):778-87
references: 22433027
references: Health Technol Assess. 2008 Mar;12(6):iii-iv, 1-270
references: 18331705
references: J Matern Fetal Neonatal Med. 2005 Jan;17(1):3-18
references: 15804781
references: J Med Econ. 2010;13(4):728-37
references: 21138338
references: J Clin Invest. 2003 Mar;111(5):649-58
references: 12618519
references: N Engl J Med. 2010 Apr 8;362(14):1282-91
references: 20375405