Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling

Abstract

The tests evaluated are not sufficiently accurate, in our opinion, to suggest their routine use in clinical practice. Calcium and antiplatelet agents, primarily low-dose aspirin, were the interventions shown to prevent pre-eclampsia. The most cost-effective approach to reducing pre-eclampsia is likely to be the provision of an effective, affordable and safe intervention applied to all mothers without prior testing to assess levels of risk. It is probably premature to suggest the implementation of a treat-all intervention strategy at present, however the feasibility and acceptability of this to women could be explored. Rigorous evaluation is needed of tests with modest cost whose initial assessments suggest that they may have high levels of both sensitivity and specificity. Similarly, there is a need for high-quality, adequately powered randomised controlled trials to investigate whether interventions such as advice to rest are indeed effective in reducing pre-eclampsia. In future, an economic model should be developed that considers not just pre-eclampsia, but other related outcomes, particularly those relevant to the infant such as perinatal death, preterm birth and small for gestational age. Such a modelling project should make provision for primary data collection on the safety of interventions and their associated costs.

Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis

“…After scrutiny, two references were excluded because they were meeting abstracts 93,94 that duplicated existing full-text references, and one was excluded because it was a systematic review that did not include any relevant index tests. 95 This systematic review, by Meads et al, 95 reviewed diagnostic methods for PE, but did not include any of this assessment's index tests. The remaining six references were three published full-text articles 33,39,96 that reported on three unique studies, and three confidential unpublished references that reported on two economic analyses provided by companies submitting evidence under the NICE Diagnostic Assessments process: Alere, Inc. 97,98 and Roche Diagnostics.…”

“…Of the 1972 potentially relevant references originally identified in the searches of test accuracy studies (see Chapter 4, Quantity and quality of research available), six 33,39,[93][94][95][96] appeared to provide information about economic studies and were retrieved for further scrutiny ( Figure 6). Three further documents reporting economic analyses were provided by companies in confidence, as part of the NICE Diagnostics Full-text articles retrieved (n = 9)…”

“…The text of the paper states that 'PE management costs include physician office visits, physical exams, regular ECONOMIC ANALYSIS NIHR Journals Library www.journalslibrary.nihr.ac.uk blood pressure checks, blood and urine tests, and cardiotocography as well as hospital stays for day assessments, intensive care, inpatient monitoring and delivery or termination of pregnancy', but provides no further information on the assumed frequency of these events or the proportions of women affected. In a table summarising cost assumptions, two published studies are referenced (Meads et al 95 and Murphy and Stirrat 100 ). However, no detail was provided on which resource use data were extracted from these sources.…”

“…Sensitivity and specificity for usual clinical assessment were based on values reported in a systematic review by Meads et al 95 The parameter values used in 2010 by Hadker et al 39 are reported as pooled averages (the paper does not state whether these are means or medians) of the values reported by Meads et al No detail was provided on the method of pooling and there was no indication of which diagnostic methods reported by Meads et al were included in the pooled estimate. Sensitivity for diagnostic tests in Meads et al ranged from 9% to 66% and specificity ranged from 74% to 96% across a range of tests.…”

Mortalidade materna por eclâmpsia

“…1 A prevenção da eclâmpsia poderá ser alcançada mediante uma efetiva assistência pré-natal na atenção primária, complementada pela atenção secundária aos grupos de risco. 5,8 Até que se tenha diagnóstico diferencial, a convulsão em gestação avançada deve ser considerada como diagnóstico de eclâmpsia, e os melhores resultados maternos e perinatais são obtidos pela adoção de protocolos padronizados em serviços de nível terciário. Orientase a conduta assistencial para medidas gerais de suporte cardiorrespiratório, terapia anticonvulsivante, tratamento anti-hipertensivo e conduta obstétrica resolutiva.…”