{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:54:32Z","timestamp":1791615272951,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Investigate cost\u2010effectiveness of first trimester pre\u2010eclampsia screening using the Fetal Medicine Foundation (FMF) algorithm and targeted aspirin prophylaxis in comparison with standard care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>London tertiary hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>5957 pregnancies screened for pre\u2010eclampsia using the National Institute for Health and Care Excellence (NICE) method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Differences in pregnancy outcomes between those who developed pre\u2010eclampsia, term pre\u2010eclampsia and preterm pre\u2010eclampsia were compared by the Kruskal\u2013Wallis and Chi\u2010square tests. The FMF algorithm was applied retrospectively to the cohort. A decision analytic model was used to estimate costs and outcomes for pregnancies screened using NICE and those screened using the FMF algorithm. The decision point probabilities were calculated using the included cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Incremental healthcare costs and QALY gained per pregnancy screened.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 5957 pregnancies, 12.8% and 15.9% were screen\u2010positive for development of pre\u2010eclampsia using the NICE and FMF methods, respectively. Of those who were screen\u2010positive by NICE recommendations, aspirin was not prescribed in 25%. Across the three groups, namely, pregnancies without pre\u2010eclampsia, term pre\u2010eclampsia and preterm pre\u2010eclampsia there was a statistically significant trend in rates of emergency caesarean (respectively 21%, 43% and 71.4%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), admission to neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and length of stay in NICU. The FMF algorithm was associated with seven fewer cases of preterm pre\u2010eclampsia, cost saving of \u00a39.06 and QALY gain of 0.00006\/pregnancy screened.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using a conservative approach, application of the FMF algorithm achieved clinical benefit and an economic cost saving.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17598","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T07:20:30Z","timestamp":1689060030000},"page":"222-230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["First trimester screening for pre\u2010eclampsia and targeted aspirin prophylaxis: a cost\u2010effectiveness cohort study"],"prefix":"10.1111","volume":"131","author":[{"given":"Diane","family":"Nzelu","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Palmer","sequence":"additional","affiliation":[{"name":"Institute for Global Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Stott","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranav","family":"Pandya","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"},{"name":"University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Casagrandi","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ammari","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2971-6865","authenticated-orcid":false,"given":"Sara","family":"Hillman","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit University College London Hospital, Elizabeth Garrett Anderson Institute for Women's Health  London UK"},{"name":"University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17493"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.117.09499"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.02.014"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1704559"},{"key":"e_1_2_11_6_1","unstructured":"National Institute for Health and Care Excellence.Antenatal care. 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