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Risk threshold for starting low dose aspirin in pregnancy to prevent preeclampsia: an opportunity at a low cost.

Bartsch E, Park AL, Kingdom JC, Ray JG - PLoS ONE (2015)

Bottom Line: The second approach uses a pre-existing concept-the minimum event rate for treatment (MERT).We suggest that eligible women need not be at "high risk" for preeclampsia to warrant ASA, but rather at some modestly elevated absolute risk of 6-10%.Given its very low cost, its widespread availability, ease of administration and its safety profile, ASA is a highly attractive agent for the prevention of maternal and perinatal morbidity worldwide.

View Article: PubMed Central - PubMed

Affiliation: Western University, London, Ontario, Canada.

ABSTRACT

Background: Preeclampsia (PE) increases maternal and perinatal morbidity and mortality. Based on a multitude of data from randomized clinical trials, clinical practice guidelines endorse using ASA to prevent PE in women who are "at risk." However, data are lacking about the level of absolute risk to warrant starting ASA prophylaxis.

Methods and findings: We present two approaches for objectively determining the minimum absolute risk for PE at which ASA prophylaxis is justified. The first is a new approach-the minimum control event rate (CERmin). The second approach uses a pre-existing concept-the minimum event rate for treatment (MERT). Here we show how the CERmin is derived, and then use the CERmin and the MERT to guide us to a reasonable risk threshold for starting a woman on ASA prophylaxis against PE based on clinical risk assessment. We suggest that eligible women need not be at "high risk" for preeclampsia to warrant ASA, but rather at some modestly elevated absolute risk of 6-10%.

Conclusions: Given its very low cost, its widespread availability, ease of administration and its safety profile, ASA is a highly attractive agent for the prevention of maternal and perinatal morbidity worldwide.

No MeSH data available.


Related in: MedlinePlus

Minimum control event rate (CERmin) for preeclampsia with varying quality-adjusted life years (QALYs) gained, at a fixed treatment event rate (TER) for preeclampsia of 6.0%.CERmin calculated as: TER + [DC / (QALYs gained x $50 000)], assuming a direct cost (DC) of ASA of $10 per pregnancy. The dashed blue lines indicate that at 0.52 QALYs gained [1], the CERmin for preeclampsia is close to the TER (6.0%). At a more modest gain of 0.05 QALYs, the CERmin increases slightly to 6.4% (dashed red lines).
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pone.0116296.g003: Minimum control event rate (CERmin) for preeclampsia with varying quality-adjusted life years (QALYs) gained, at a fixed treatment event rate (TER) for preeclampsia of 6.0%.CERmin calculated as: TER + [DC / (QALYs gained x $50 000)], assuming a direct cost (DC) of ASA of $10 per pregnancy. The dashed blue lines indicate that at 0.52 QALYs gained [1], the CERmin for preeclampsia is close to the TER (6.0%). At a more modest gain of 0.05 QALYs, the CERmin increases slightly to 6.4% (dashed red lines).

Mentions: If we fix the TER at 6.0%—a rate observed in many ASA RCTs [11, 12, 14]—we see how the CERmin changes with varying QALYs gained (Fig. 3). The CERmin declines with increasing QALYs gained, but these changes become very minor above a QALY gain of 0.05.


Risk threshold for starting low dose aspirin in pregnancy to prevent preeclampsia: an opportunity at a low cost.

Bartsch E, Park AL, Kingdom JC, Ray JG - PLoS ONE (2015)

Minimum control event rate (CERmin) for preeclampsia with varying quality-adjusted life years (QALYs) gained, at a fixed treatment event rate (TER) for preeclampsia of 6.0%.CERmin calculated as: TER + [DC / (QALYs gained x $50 000)], assuming a direct cost (DC) of ASA of $10 per pregnancy. The dashed blue lines indicate that at 0.52 QALYs gained [1], the CERmin for preeclampsia is close to the TER (6.0%). At a more modest gain of 0.05 QALYs, the CERmin increases slightly to 6.4% (dashed red lines).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4366221&req=5

pone.0116296.g003: Minimum control event rate (CERmin) for preeclampsia with varying quality-adjusted life years (QALYs) gained, at a fixed treatment event rate (TER) for preeclampsia of 6.0%.CERmin calculated as: TER + [DC / (QALYs gained x $50 000)], assuming a direct cost (DC) of ASA of $10 per pregnancy. The dashed blue lines indicate that at 0.52 QALYs gained [1], the CERmin for preeclampsia is close to the TER (6.0%). At a more modest gain of 0.05 QALYs, the CERmin increases slightly to 6.4% (dashed red lines).
Mentions: If we fix the TER at 6.0%—a rate observed in many ASA RCTs [11, 12, 14]—we see how the CERmin changes with varying QALYs gained (Fig. 3). The CERmin declines with increasing QALYs gained, but these changes become very minor above a QALY gain of 0.05.

Bottom Line: The second approach uses a pre-existing concept-the minimum event rate for treatment (MERT).We suggest that eligible women need not be at "high risk" for preeclampsia to warrant ASA, but rather at some modestly elevated absolute risk of 6-10%.Given its very low cost, its widespread availability, ease of administration and its safety profile, ASA is a highly attractive agent for the prevention of maternal and perinatal morbidity worldwide.

View Article: PubMed Central - PubMed

Affiliation: Western University, London, Ontario, Canada.

ABSTRACT

Background: Preeclampsia (PE) increases maternal and perinatal morbidity and mortality. Based on a multitude of data from randomized clinical trials, clinical practice guidelines endorse using ASA to prevent PE in women who are "at risk." However, data are lacking about the level of absolute risk to warrant starting ASA prophylaxis.

Methods and findings: We present two approaches for objectively determining the minimum absolute risk for PE at which ASA prophylaxis is justified. The first is a new approach-the minimum control event rate (CERmin). The second approach uses a pre-existing concept-the minimum event rate for treatment (MERT). Here we show how the CERmin is derived, and then use the CERmin and the MERT to guide us to a reasonable risk threshold for starting a woman on ASA prophylaxis against PE based on clinical risk assessment. We suggest that eligible women need not be at "high risk" for preeclampsia to warrant ASA, but rather at some modestly elevated absolute risk of 6-10%.

Conclusions: Given its very low cost, its widespread availability, ease of administration and its safety profile, ASA is a highly attractive agent for the prevention of maternal and perinatal morbidity worldwide.

No MeSH data available.


Related in: MedlinePlus