Preeclampsia prevention using routine versus screening test-indicated aspirin in low-risk women a cost-effectiveness analysis

Fionnuala Mone, James F. O'Mahony, Ella Tyrrell, Cecilia Mulcahy, Peter McParland, Fionnuala Breathnach, John J. Morrison, John Higgins, Sean Daly, Amanda Cotter, Alyson Hunter, Patrick Dicker, Elizabeth Tully, Fergal D. Malone, Charles Normand, Fionnuala M. McAuliffe*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


The objective was to evaluate whether routine aspirin 75 mg is more cost-effective than the Fetal Medicine Foundation screen-and-treat approach for preeclampsia prevention in low-risk nulliparous women. A health economic decision analytical model was devised to estimate the discounted net health and cost outcomes of routine aspirin versus Fetal Medicine Foundation screening test-indicated aspirin for a cohort of 100 000 low-risk nulliparous women. Both strategies were compared with no intervention. A subanalysis also compared disaggregated components of the algorithm. The analysis used data from hospital administration, literature, and a randomized controlled trial. Sensitivity analyses assessed the impact of aspirin adherence, test cost, and accuracy on study results. Presumed rates of preeclampsia were 3.75% with no intervention versus 0.45% with aspirin use. Results found that routine aspirin was the preferred strategy, in terms of greater health gains and larger cost savings. It provided 163 quality-adjusted life-years relative to no intervention, whereas the screen-and-treat policy achieved 108 quality-adjusted life-years. Routine aspirin would result in an estimated cost saving of €14.9 million annually relative to no intervention, whereas screen-and-treat approach would result in a smaller cost saving of €3.1 million. When the analysis was extended to consider alternative screen-and-treat strategies, routine aspirin remained the optimally cost-effective approach. In conclusion, routine aspirin use in low-risk nulliparous women has a greater health gain and cost saving compared with both the Fetal Medicine Foundation and other screen-and-treat approaches.

Original languageEnglish
Pages (from-to)1391-1396
Number of pages6
Issue number6
Publication statusPublished - Dec 2018


  • Aspirin
  • Biomarkers
  • Cost analysis
  • Preeclampsia
  • Pregnancy
  • Prevention


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