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Randomized Controlled Trial
. 2025 Apr;169(1):399-407.
doi: 10.1002/ijgo.16024. Epub 2024 Nov 28.

Cost-effectiveness of a randomized controlled trial comparing low-dose aspirin to placebo for the prevention of recurrent preterm birth

Anadeijda J E M C Landman  1   2 , Hana M Broulikova  3 , Laura Visser  1   2 , Tobias A J Nijman  4 , Marieke A C Hemels  5 , Karin C Vollebregt  6 , Elisabeth M A Boormans  7 , Henk A Bremer  8 , Esther Tuinman  9 , Josje Langenveld  10 , Flip van der Made  11 , Robbert J P Rijnders  12 , Huib A A M van Vliet  13 , Liv M Freeman  14 , Roel de Heus  15 , Judith Blaauw  16 , Ineke Krabbendam  17 , Rafli van de Laar  18 , Marieke F G Verberg  19 , Hubertina C J Scheepers  20 , Ben W Mol  21   22 , Christianne J M de Groot  1   2 , Martijn A Oudijk  1   2 , Judith E Bosmans  3 , Marjon A de Boer  1   2
Affiliations
Randomized Controlled Trial

Cost-effectiveness of a randomized controlled trial comparing low-dose aspirin to placebo for the prevention of recurrent preterm birth

Anadeijda J E M C Landman et al. Int J Gynaecol Obstet. 2025 Apr.

Abstract

To assess the cost-effectiveness of low-dose aspirin compared to placebo for the prevention of recurrent preterm birth from a healthcare perspective. This was a cost-effectiveness analysis alongside a multicenter, randomized, double-blinded, placebo-controlled trial. We included women with a singleton pregnancy and a previous spontaneous preterm birth <37 weeks of gestation of a singleton. Women were randomized between aspirin 80 mg daily and placebo, initiated between 8 and 16 weeks of gestation. We estimated the difference in preterm births (<37 weeks of gestation), and maternal and neonatal healthcare costs using seemingly unrelated linear regression analyses. Bootstrapping was performed to estimate statistical uncertainty. A total of 387 women were included: 194 in the aspirin group and 193 in the placebo group. We observed a small, statistically non-significant difference in preterm birth (21.2% vs. 25.4%; risk difference -4.3%; 95% CI: -12.7% to 4.1%) and healthcare costs (mean -€99; 95% CI: -€2385 to €2325) in the aspirin group compared to placebo. The cost-effectiveness acceptability curve showed that the probability of aspirin being cost-effective was 54% for a willingness to pay threshold of €0 for one prevented preterm birth and 78% for €50 000 for one prevented preterm birth. Our findings suggest that aspirin is the dominant strategy over placebo for the prevention of preterm birth. However, there was substantial uncertainty around the results and definite conclusions regarding the cost-effectiveness of aspirin cannot be drawn.

Keywords: acetylsalicylic acid; aspirin; cost‐effectiveness; economic analysis; perinatal outcome; preterm birth.

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Conflict of interest statement

Professor Mol reported an Investigator grant from the National Health and Medical Research Council (NHMRC; grant no. GNT1176437); receipt of research funding from Guerbet and is a former advisory board member at ObsEva. All other authors do not report any relevant financial activities outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Cost‐effectiveness plane.
FIGURE 2
FIGURE 2
Cost‐effectiveness acceptability curve.
See this image and copyright information in PMC

References

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