Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany
Abstract Background The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative p...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3406-1 |
| _version_ | 1818197284018454528 |
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| author | Dietmar Schlembach Martin Hund Annabel Schroer Cyrill Wolf |
| author_facet | Dietmar Schlembach Martin Hund Annabel Schroer Cyrill Wolf |
| author_sort | Dietmar Schlembach |
| collection | DOAJ |
| description | Abstract Background The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the next 4 weeks. We performed an assessment of the economic impact of the sFlt-1/PlGF ratio test for short-term prediction of preeclampsia in Germany. Methods We adapted a cost-effectiveness model, which had been developed to estimate the incremental value of adding the sFlt-1/PlGF ratio test with a cut-off ratio of 38 to standard diagnostic procedures for guiding the management of women with suspected preeclampsia in the UK. We used the adapted model to estimate the incremental value of the sFlt-1/PlGF ratio test (cut-off 38) for guiding the management of women with suspected preeclampsia from a German Diagnosis-Related Group (DRG) payer perspective. The economic model estimated costs associated with diagnosis and management of preeclampsia in women managed in either a ‘no-test’ scenario in which clinical decisions are based on standard diagnostic procedures alone, or a ‘test’ scenario in which the sFlt-1/PlGF test is used in addition to standard diagnostic procedures. Test characteristics and rates of hospitalization were derived from patient-level data from PROGNOSIS. The main outcome measure from the economic model was the total cost per patient. Results In the model adapted to the German DRG payer system, introduction of the sFlt-1/PlGF ratio test with a cut-off value of 38 could reduce the proportion of women hospitalized in Germany from 44.6 to 24.0%, resulting in an expected cost saving of €361 per patient. Conclusions The sFlt-1/PlGF ratio test is likely to reduce unnecessary hospitalization of women with a low risk of developing preeclampsia, and identify those at high risk to ensure appropriate management. Even within the restrictions of the DRG system in Germany, this results in substantial cost savings for women with suspected preeclampsia. |
| first_indexed | 2024-12-12T01:47:31Z |
| format | Article |
| id | doaj.art-0c2db108c88e451b880f481b987ff278 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T01:47:31Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-0c2db108c88e451b880f481b987ff2782022-12-22T00:42:33ZengBMCBMC Health Services Research1472-69632018-08-0118111110.1186/s12913-018-3406-1Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in GermanyDietmar Schlembach0Martin Hund1Annabel Schroer2Cyrill Wolf3Vivantes Network of Health, Clinicum Neukoelln, Clinic of ObstetricsRoche Diagnostics International LtdRoche Diagnostics Germany GmbHRoche Diagnostics International LtdAbstract Background The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the next 4 weeks. We performed an assessment of the economic impact of the sFlt-1/PlGF ratio test for short-term prediction of preeclampsia in Germany. Methods We adapted a cost-effectiveness model, which had been developed to estimate the incremental value of adding the sFlt-1/PlGF ratio test with a cut-off ratio of 38 to standard diagnostic procedures for guiding the management of women with suspected preeclampsia in the UK. We used the adapted model to estimate the incremental value of the sFlt-1/PlGF ratio test (cut-off 38) for guiding the management of women with suspected preeclampsia from a German Diagnosis-Related Group (DRG) payer perspective. The economic model estimated costs associated with diagnosis and management of preeclampsia in women managed in either a ‘no-test’ scenario in which clinical decisions are based on standard diagnostic procedures alone, or a ‘test’ scenario in which the sFlt-1/PlGF test is used in addition to standard diagnostic procedures. Test characteristics and rates of hospitalization were derived from patient-level data from PROGNOSIS. The main outcome measure from the economic model was the total cost per patient. Results In the model adapted to the German DRG payer system, introduction of the sFlt-1/PlGF ratio test with a cut-off value of 38 could reduce the proportion of women hospitalized in Germany from 44.6 to 24.0%, resulting in an expected cost saving of €361 per patient. Conclusions The sFlt-1/PlGF ratio test is likely to reduce unnecessary hospitalization of women with a low risk of developing preeclampsia, and identify those at high risk to ensure appropriate management. Even within the restrictions of the DRG system in Germany, this results in substantial cost savings for women with suspected preeclampsia.http://link.springer.com/article/10.1186/s12913-018-3406-1Angiogenic factorsCost-effectivenessCost-savingDiagnosisEconomicDiagnosis-related group |
| spellingShingle | Dietmar Schlembach Martin Hund Annabel Schroer Cyrill Wolf Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany BMC Health Services Research Angiogenic factors Cost-effectiveness Cost-saving Diagnosis Economic Diagnosis-related group |
| title | Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany |
| title_full | Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany |
| title_fullStr | Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany |
| title_full_unstemmed | Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany |
| title_short | Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany |
| title_sort | economic assessment of the use of the sflt 1 plgf ratio test to predict preeclampsia in germany |
| topic | Angiogenic factors Cost-effectiveness Cost-saving Diagnosis Economic Diagnosis-related group |
| url | http://link.springer.com/article/10.1186/s12913-018-3406-1 |
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