Yearly hypertension screening in women with a history of pre-eclampsia: a cost-effectiveness analysis

Abstract

Background: Women with a history of preeclampsia are at increased risk for future hypertension and cardiovascular disease (CVD); until now it is not clear whether preventive measures are needed.

Methods: A decision-analytic Markov model was constructed to evaluate healthcare costs and effects of screening and treatment (100 % compliance) for hypertension post preeclampsia based on the available literature. Cardiovascular events and CVD mortality were defined as health states. Outcomes were measured in absolute costs, events, life-years and quality-adjusted life-years (QALYs). Sensitivity and threshold analyses were performed to address uncertainty.

Results: Over a 20-year time horizon, events occurred in 7.2 % of the population after screening, and in 8.5 % of the population without screening. QALYs increased from 16.37 (no screening strategy) to 16.40 (screening strategy), an increment of 0.03 (95 % CI 0.01;0.05) QALYs. Total expected costs were € 8016 in the screening strategy, and € 9087 in the none screening strategy (expected saving of € 1071 (95 % CI - 3146;-87) per person).

Conclusion: Annual hypertension screening and treatment in women with a history of preeclampsia may save costs, for at least a similar quality of life and survival due to prevented CVD compared with standard care.

Keywords: Cardiovascular screening; Economic analysis; Preeclampsia.

Fig. 1

Schematic representation of the Markov model.

Fig. 2

Effectiveness of screening for hypertension post preeclampsia according to the probabilistic analysis in 20 year time horizon

Fig. 3

Cost-effectiveness acceptability curves for hypertension screenig in women post preeclampsia, combined results for 10 and 20 year time horizon