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

Abstract

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.

Contribution of placental 11β‐HSD2 to the pathogenesis of preeclampsia

“…Among them, imbalance release of sFlt1 and PlGF plays critical roles in PE development 3,4 . Many studies have shown that sFlt1/PlGF ratio is markedly increased in PE patients and in women with pre‐existing conditions predisposing or mimicking PE 43–46 . In consistence with these studies, we demonstrated that an increased circulatory sFlt1/PlGF ratio was found in the rats with PE‐like features induced by placental 11β‐HSD2 downregulation.…”

Economic evaluation of the sFlt-1/PlGF ratio for the short-term prediction of preeclampsia in a Japanese cohort of the PROGNOSIS Asia study

“…Analysis of the economic impact in the UK indicated that hospitalizations of women with suspected preeclampsia were reduced by 56%, resulting in net savings of £344 per patient for the healthcare provider [28]. The substantial cost saving results per patient were replicated in Italy (€670) [25], Germany (€361) [27], Brazil (R $185-636) [24], Switzerland (€346) [26], and the US ($1,215) [29]. Taken together, these studies show that the sFlt-1/PlGF ratio test yields cost savings for different populations/geographical areas and from the perspective of a range of healthcare providers with different procedures and financial models.…”

“…PlGF, placental growth factor; PROGNOSIS, PRediction of short-term Outcomes in preGNant wOmen with Suspected preeclampsIa Study; sFlt-1, soluble fms-like tyrosine kinase-1 addition to its clinical performance. Similar research on the cost analysis of introducing the sFlt-1/PlGF ratio test has been performed using population-level data from PROG-NOSIS in the UK, Italy, Germany, Brazil, Switzerland, and the US [24][25][26][27][28][29][30]. In PROGNOSIS, the sFlt-1/PlGF ratio has been shown to improve the short-term prediction of preeclampsia in women with clinical suspicion of the condition, and NICE guidelines recommend the use of the sFlt-1/ PlGF ratio test to rule out preeclampsia, in addition to standard care, in women between 20 and 34 weeks + 6 days of gestation [35].…”

“…The economic impact of implementing the sFlt-1/PlGF ratio test, based on PROGNOSIS data, has been assessed in the UK, Italy, Brazil, Germany, Switzerland, and the US [24][25][26][27][28][29][30]. The authors concluded that introducing the test into clinical practice for women with suspected preeclampsia would provide cost savings for the respective healthcare providers, mainly due to the increased ability to rule out preeclampsia and thereby reduce unnecessary hospitalizations.…”

1‐O‐Hexyl‐2,3,5‐Trimethylhydroquinone Ameliorates the Development of Preeclampsia through Suppression of Oxidative Stress and Endothelial Cell Apoptosis

“…Oxidative stress is characterized by the imbalance between the generation of reactive oxygen species (ROS) and the antioxidant defence system, [ 9 , 10 ]. ROS can induce placental dysfunction by suppression of placental angiogenesis, induction endothelial damage, and immune malfunction, which are suggested to be the underlying of PE development [ 11 – 13 ]. Several studies have found suppressing oxidative stress, and scavenging ROS represents potential therapeutic opportunities for the treatment of PE development [ 11 ] [ 14 ].…”