Economic aspects of introducing tests for early diagnosis of preeclampsia into the routine practice of managing pregnancy
- Authors: Avxentyev N.A.1,2, Makarov A.S.2, Khodzhaeva Z.S.3, Travkina A.A.4, Medvedev A.P.5, Ivanets T.Y.3
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Affiliations:
- Financial Research Institute, Ministry of Finance of the Russian Federation
- Health and Market Access Consulting LLC
- Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
- Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology
- Institute of Economics of the Russian Academy of Sciences
- Issue: No 6 (2024)
- Pages: 134-144
- Section: Guidelines for the Practitioner
- URL: https://journals.rcsi.science/0300-9092/article/view/260566
- DOI: https://doi.org/10.18565/aig.2024.141
- ID: 260566
Cite item
Abstract
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.
Full Text
##article.viewOnOriginalSite##About the authors
Nicolay A. Avxentyev
Financial Research Institute, Ministry of Finance of the Russian Federation; Health and Market Access Consulting LLC
Author for correspondence.
Email: na@nifi.ru
ORCID iD: 0000-0002-2686-1330
Advisor-director
Russian Federation, Moscow; MoscowAlexander S. Makarov
Health and Market Access Consulting LLC
Email: am@health-ma.ru
ORCID iD: 0000-0002-0723-6011
Senior Researcher
Russian Federation, MoscowZulfiya S. Khodzhaeva
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: zkhodjaeva@mail.ru
ORCID iD: 0000-0001-8159-3714
Dr. Med. Sci., Professor, Deputy Director for Research of the Institute of Obstetrics
Russian Federation, MoscowArina A. Travkina
Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology
Email: arinamamba@mail.ru
ORCID iD: 0000-0003-0494-7413
SPIN-code: 3230-1452
PhD, Senior Researcher at the Sequential Obstetric Department
Russian Federation, MoscowAlexander P. Medvedev
Institute of Economics of the Russian Academy of Sciences
Email: medvedfa@gmail.com
ORCID iD: 0009-0007-6272-9162
postgraduate student
Russian Federation, MoscowTatyana Yu. Ivanets
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: t_ivanets@oparina4.ru
ORCID iD: 0000-0002-7990-0276
SPIN-code: 3103-6737
Dr. Med. Sci., Head of the Clinical Diagnostic Laboratory
Russian Federation, MoscowReferences
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