Cost-benefit analysis of first-trimester pre-eclampsia screening: comparison of multivariable Gaussian algorithm with and without placental growth factor.

Abstract

Pre-eclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality worldwide. Early identification of high-risk pregnancies in the first trimester allows preventive treatment with low-dose aspirin. This study aimed to evaluate whether multivariable Gaussian algorithm-based PE screening strategies, with and without placental growth factor (PlGF), are cost beneficial compared with no screening. The cost-benefit analysis estimated the total healthcare savings for the two screening strategies compared with no screening, considering both the costs associated with implementing the screening and the savings derived from the number of cases of PE and preterm infants prevented. The analysis was based on real-world data from Catalan maternity centers applied to a cohort of 56 344 pregnancies (annual birth rate in 2023). Univariable sensitivity and best- and worst-case scenario analyses were also conducted. Both screening strategies resulted in cost savings compared with no screening. The Gaussian algorithm without PlGF yielded greater healthcare savings (€3.38 million) than did the Gaussian algorithm with PlGF (€3.29 million). However, the addition of PlGF provided greater clinical benefit, preventing a higher number of PE cases. Sensitivity analysis identified PE incidence and preterm birth rates as the primary cost drivers. For the PlGF strategy to be cost beneficial, the PlGF reagent cost per unit should not exceed €4.31. Although the Gaussian algorithm without PlGF demonstrated the highest cost savings compared with no screening, incorporating PlGF further improved PE prevention, supporting its broader adoption. A PlGF reagent cost per unit below €4.31 may make this strategy cost-beneficial, enhancing its clinical implementation. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.