Economic evaluation of sFlt-1/PlGF ratio test in pre-eclampsia prediction and diagnosis in two Brazilian hospitals

Abstract

OBJECTIVES: To assess the economic impact of introducing the soluble FMS-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test into clinical practice in two Brazilian hospitals. METHODS: An economic model estimating the incremental value of the information from a Brazilian public and private healthcare payer perspective generated by the sFlt-1/PlGF ratio test, compared with current diagnostic procedures, in guiding the management of women with suspected pre-eclampsia. A cohort of 1000 pregnant women between 24 weeks and 36 + 6 weeks of gestation were managed in either a 'test' scenario in which the sFlt-1/PlGF test is used in addition to current diagnostic procedures, or a 'no-test' scenario. Information on the costs associated with diagnosis, prediction and management were derived from the cost database of Hospital M'Boi Mirim (public) and Hospital Einstein (private). The probabilities used in the decision tree were derived from PROGNOSIS. The main outcome measure from the model was the cost per patient per episode of care (from first suspicion of pre-eclampsia to birth). RESULTS: Introduction of the sFlt-1/PlGF ratio test resulted in cost savings in both settings (M'Boi Mirim: R$185.06 and Einstein: R$635.84 per patient) compared with a 'no-test' scenario. Savings are generated primarily through an improvement in diagnostic accuracy and a reduction in unnecessary hospitalization. CONCLUSIONS: The sFlt-1/PlGF ratio test has the potential to improve clinical decision-making and allocation of scarce resources by reducing unnecessary hospitalization of women at low risk of developing pre-eclampsia, and ensuring that women at higher risk are identified and managed appropriately.