Economic aspects of introducing tests for early diagnosis of preeclampsia into the routine practice of managing pregnancy
Avxentyev N.A., Makarov A.S., Khodzhaeva Z.S., Travkina A.A., Medvedev A.P., Ivanets T.Yu.
Preeclampsia is one of the most serious pregnancy complications affecting 2-8% of pregnancies. In the last decade, it has become possible to detect preeclampsia early by determining the ratio of angiogenic factors sFlt-1/PlGF; thus, the incidence of maternal and perinatal complications may be reduced.
Objective: To assess the impact of introducing the sFlt-1/PlGF ratio for early diagnosis of preeclampsia into the routine practice of managing pregnancy on clinical outcomes and health care system costs in the Russian Federation.
Materials and methods: The study was based on a mathematical model to determine the ratio of angiogenic factors sFlt-1/PlGF in all pregnant women at high risk of preeclampsia; these factors were determined by first trimester screening. The initial data for building the model were the results of the PROGNOSIS clinical trial, statistical materials and a survey of experts. The early detection of preeclampsia was expected to contribute to the improvement of pregnancy management tactics and reduce the health care costs, including preventive care, emergency and planned hospitalizations, and treatment of pregnancy complications. The developed model was tested in the Moscow region, the Samara region and the Republic of Bashkortostan.
Results: The introduction of testing into the routine practice of managing pregnancy may reduce the incidence of life-threatening complications for the pregnant woman (severe preeclampsia, HELLP syndrome) and fetus/newborn (stillbirth, perinatal mortality, respiratory distress syndrome, periventricular leukomalacia). Due to the decrease in the number of cases of providing medical care for patients who do not develop preeclampsia (misdiagnosed without a test), as well as the decrease in the number of emergency hospitalizations and deliveries for patients who have preeclampsia outside the hospital (in the absence of timely diagnosis), the total costs of the Obligatory Medical Insurance system will not increase if the average number of tests is 1.45 or less per pregnant woman with a high risk of developing preeclampsia.
Conclusion: The introduction of the sFlt-1/PlGF ratio into the routine practice of managing patients at high risk for preeclampsia has the potential to reduce adverse pregnancy outcomes and the cost of managing pregnancy.
Authors’ contributions: Avxentyev N.A., Makarov A.S., Khodzhaeva Z.S., Travkina A.A., Medvedev A.P., Ivanets T.Yu. – developing the concept and design of the study, collecting and processing the material, statistical processing of the data, writing the text, editing the article. All authors made equivalent contributions to the publication.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Acknowledgements: The authors express they gratitude to Roman V. Kapustin, Dr. Med. Sci., Head of the Department of Obstetrics and Perinatology in the D.O. Ott Research Institute of Obstetrics, Gynecology and Reproduction (St. Petersburg), for expert and methodological assistance in the preparation of this publication.
For citation: Avxentyev N.A., Makarov A.S., Khodzhaeva Z.S., Travkina A.A., Medvedev A.P., Ivanets T.Yu. Economic aspects of introducing tests for early diagnosis of preeclampsia into the routine practice of managing pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (6): 134-144 (in Russian)
https://dx.doi.org/10.18565/aig.2024.141
Keywords
preeclampsia
pharmacoeconomic analysis
budget impact analysis
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Received 14.06.2024
Accepted 20.06.2024
About the Authors
Nicolay A. Avxentyev, Advisor-director, Financial Research Institute, Ministry of Finance of the Russian Federation, Russia, 127006, Russia, Moscow, Nastasyinsky Lane, 3, b. 2, +7(495)699-74-14, na@nifi.ru, https://orcid.org/0000-0002-2686-1330Alexander S. Makarov, Senior Researcher, Health and Market Access Consulting Limited Liability Company, 109378, Russia, Moscow, Volgogradsky Ave., 157, b. 1, +7(916)203-39-23, am@health-ma.ru, https://orcid.org/0000-0002-0723-6011
Zulfiya S. Khodzhaeva, Dr. Med. Sci., Professor, Deputy Director for Research of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(916)407-75-67, zkhodjaeva@mail.ru, https://orcid.org/0000-0001-8159-3714
Arina A. Travkina, PhD, Senior Researcher at the Sequential Obstetric Department, Academician V.N. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22a, +7(495)625-08-52, arinamamba@mail.ru, SPIN-code: 3230-1452, https://orcid.org/0000-0003-0494-7413
Alexander P. Medvedev, postgraduate student, Institute of Economics of the Russian Academy of Sciences, 117218, Moscow, Russia, Nakhimovsky Ave., 32, +7(915)280-50-10, medvedfa@gmail.com, https://orcid.org/0009-0007-6272-9162
Tatyana Yu. Ivanets, Dr. Med. Sci., Head of the Clinical Diagnostic Laboratory, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(910)404-26-69, t_ivanets@oparina4.ru, SPIN-code: 3103-6737, https://orcid.org/0000-0002-7990-0276
Corresponding author: Nicolay A. Avxentyev, na@nifi.ru
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