Cost-Effectiveness Analysis Of Biomarker-Based And Risk-Based Screening In Early Detection Of Preeclampsia: Systematic Review
Main Article Content
Abstract
Preeclampsia is one of the leading causes of maternal morbidity and mortality, especially in developing countries. Evaluation of the cost-effectiveness of first-trimester screening is essential to ensure accurate and efficient interventions. The objective of this review is to examine and compare the cost-effectiveness between biomarker-based preeclampsia screening and maternal risk-based screening in the first trimester of pregnancy. This study used a systematic review method based on the PRISMA guidelines. Articles searched through PubMed and ScienceDirect with a range of 2020–2025. Quality assessment using the CHEERS Checklist. Five studies were included in this review. All studies show that first-trimester preeclampsia screening is a cost-effective, even cost-saving strategy, especially when combined with early aspirin. Biomarker-based screening and risk algorithms are more cost-efficient than conventional screening. These results can be the basis for the formulation of maternal health policies in Indonesia. Preeclampsia, first trimester screening, cost-effectiveness, biomarkers.
Downloads
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007;369(9575):1791–1798.
Beernink RHJ, Scherjon SA, Cremers TIFH, van Asselt ADI. Cost-effectiveness analysis of a first-trimester screening test for preterm preeclampsia in the Netherlands. Eur J Obstet Gynecol Reprod Biol. 2022;272:13–18.
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy. Hypertension. 2018;72(1):24–43.
Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. Lancet. 2021;398(10297):341–354.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130–137.
Gillon TE, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review. PLoS One. 2014;9(12):e113715.
Henderson JT, Thompson JH, Burda BU, Cantor A, Beil T, Whitlock EP. Screening for preeclampsia: systematic review for USPSTF. JAMA. 2017;317(16):1668–1683.
Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and eclampsia. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391–403.
Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis and management of hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014;4(2):105–145
Mewes JC, Lindenberg M, Vrijhoef HJM. Cost-effectiveness analysis of screening for preterm pre-eclampsia in Germany and Switzerland. PLoS One. 2020;15(4):e0232278.
Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016;387(10022):999–1011.
Myers JE, Kenny LC, McCowan LM, Chan EH, Dekker GA, Poston L, et al. Angiogenic biomarkers for prediction of preeclampsia. Lancet. 2013;382(9888):195–205.
Napolitano R, Nzelu D, Palmer T, Stott D, Pandya P, Casagrandi D, et al. First trimester screening for pre-eclampsia and aspirin prophylaxis: cost-effectiveness study. BJOG. 2023;130(11):1263–1271.
NICE. Hypertension in pregnancy: diagnosis and management (NG133). London: NICE; 2019.
O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, Wright A, et al. Multicenter screening for pre-eclampsia. Am J Obstet Gynecol. 2017;216(1):54.e1–54.e15.
Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. FIGO initiative on pre-eclampsia. Int J Gynaecol Obstet. 2019;145(S1):1–33.
Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: pathophysiology and biomarkers. Circ Res. 2019;124(7):1094–1112.
Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin vs placebo in high-risk pregnancies. N Engl J Med. 2017;377(7):613–622.
Tan MY, Wright D, Syngelaki A, Akolekar R, Cicero S, Janga D, et al. Diagnostic accuracy of early screening. Ultrasound Obstet Gynecol. 2018;51(6):743–750.
van Montfort P, Scheepers HCJ, Dirksen CD, van Dooren IMA, van Kuijk SMJ, Meertens LJE, et al. Cost-effectiveness of risk-based care. Am J Obstet Gynecol. 2021;225(5):559.e1–559.e10.
Violago CJG, Quinio IB. Cost-effectiveness of first trimester screening and aspirin therapy. Philipp J Obstet Gynecol. 2023;47(1):26–33.
World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia. Geneva: WHO; 2011.
World Health Organization. Antenatal care guidelines. Geneva: WHO; 2022.
Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening. Am J Obstet Gynecol. 2015;213(1):62.e1–62.e10.
Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, et al. Preeclampsia and future cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2017;10(2):e003497.
Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive value of sFlt-1/PlGF ratio. N Engl J Med. 2016;374(1):13–22.