title: A Cost-Benefit Analysis of Low-Dose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States.
abstract: OBJECTIVE
  To develop a decision model to evaluate the risks, benefits, and costs of different approaches to aspirin prophylaxis for the approximately 4 million pregnant women in the United States annually.
  
  
  METHODS
  We created a decision model to evaluate four approaches to aspirin prophylaxis in the United States: no prophylaxis, prophylaxis per American College of Obstetricians and Gynecologists (the College) recommendations, prophylaxis per U.S. Preventive Services Task Force recommendations, and universal prophylaxis. We included the costs associated with aspirin, preeclampsia, preterm birth, and potential aspirin-associated adverse effects. TreeAge Pro 2011 was used to perform the analysis.
  
  
  RESULTS
  The estimated rate of preeclampsia would be 4.18% without prophylaxis compared with 4.17% with the College approach in which 0.35% (n=14,000) of women receive aspirin, 3.83% with the U.S. Preventive Services Task Force approach in which 23.5% (n=940,800) receive aspirin, and 3.81% with universal prophylaxis. Compared with no prophylaxis, the U.S. Preventive Services Task Force approach would save $377.4 million in direct medical care costs annually, and universal prophylaxis would save $365 million assuming 4 million births each year. The U.S. Preventive Services Task Force approach is the most cost-beneficial in 79% of probabilistic simulations. Assuming a willingness to pay of $100,000 per neonatal quality-adjusted life-year gained, the universal approach is the most cost-effective in more than 99% of simulations.
  
  
  CONCLUSIONS
  Both the U.S. Preventive Services Task Force approach and universal prophylaxis would reduce morbidity, save lives, and lower health care costs in the United States to a much greater degree than the approach currently recommended by the College.
authors.affiliation: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, and the Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
authors.forename: Alisse K
authors.initials: AK
authors.lastname: Hauspurg
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
mesh_terms: D000284:Administration, Oral; D001241:Aspirin / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D018803:Models, Economic; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000191:economics / Q000517:prevention & control*; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics / Q000517:prevention & control; D011295:Prenatal Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin