Impact of preventive screening and lifestyle interventions in women with a history of preeclampsia: A micro-simulation study
Lagerweij, G R; Brouwers, L; De Wit, G A; Moons, Kgm; Benschop, L; Maas, Ahem; Franx, A; Wermer, Marieke J H; Roeters Van Lennep, Jeanine E.; van Rijn, B B; Koffijberg, H
(2020) European Journal of Preventive Cardiology, volume 27, issue 13, pp. 1389 - 1399
(Article)
Abstract
BACKGROUND: Preeclampsia is a female-specific risk factor for the development of future cardiovascular disease. Whether early preventive cardiovascular disease risk screenings combined with risk-based lifestyle interventions in women with previous preeclampsia are beneficial and cost-effective is unknown. METHODS: A micro-simulation model was developed to assess the life-long impact of preventive
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cardiovascular screening strategies initiated after women experienced preeclampsia during pregnancy. Screening was started at the age of 30 or 40 years and repeated every five years. Data (initial and follow-up) from women with a history of preeclampsia was used to calculate 10-year cardiovascular disease risk estimates according to Framingham Risk Score. An absolute risk threshold of 2% was evaluated for treatment selection, i.e. lifestyle interventions (e.g. increasing physical activity). Screening benefits were assessed in terms of costs and quality-adjusted-life-years, and incremental cost-effectiveness ratios compared with no screening. RESULTS: Expected health outcomes for no screening are 27.35 quality-adjusted-life-years and increase to 27.43 quality-adjusted-life-years (screening at 30 years with 2% threshold). The expected costs for no screening are €9426 and around €13,881 for screening at 30 years (for a 2% threshold). Preventive screening at 40 years with a 2% threshold has the most favourable incremental cost-effectiveness ratio, i.e. €34,996/quality-adjusted-life-year, compared with other screening scenarios and no screening. CONCLUSIONS: Early cardiovascular disease risk screening followed by risk-based lifestyle interventions may lead to small long-term health benefits in women with a history of preeclampsia. However, the cost-effectiveness of a lifelong cardiovascular prevention programme starting early after preeclampsia with risk-based lifestyle advice alone is relatively unfavourable. A combination of risk-based lifestyle advice plus medical therapy may be more beneficial.
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Keywords: Cardiovascular disease prevention, cost-effectiveness, lifestyle intervention, preeclampsia, primary prevention, Cardiology and Cardiovascular Medicine, Epidemiology, Journal Article
ISSN: 2047-4873
Publisher: SAGE Publications Ltd
Note: Funding Information: The consortium members consist of (in alphabetical order): Y Appelman 1, S Baart2,3, L Benschop2,3, E Boersma 2, L Brouwers3,4, RPJ Budde 2, SC Cannegieter 5, V Dam3,6, R Eijkemans 6, BCJM Fauser 4, MD Ferrari 5, A Franx 4, CJM de Groot 1, MN Gunning3,4, A Hoek 7, H Koffijberg6,8, MPH Koster 2, MC Kruit 5, GR Lagerweij3,6, CB Lambalk 1, JSE Laven 2, KM Linstra2,3,5, A van der Lugt 2, AHEM Maas 9, A Maassen van den Brink 2, C Meun2,3, S Middeldorp10, KGM Moons 6, BB van Rijn2,4, JE Roeters van Lennep2, JW Roos-Hesselink 2, LJJ Scheres3,10, YT van der Schouw 6, EAP Steegers 2, RPM Steegers-Theunissen 2, GM Terwindt 5, BK Velthuis 4, MJH Wermer 5, B Zick2,5, GA Zoet.3,4 1 Vrije Universiteit Medical Center, the Netherlands; 2 Erasmus University Medical Center, the Netherlands; 3 Netherlands Heart Institute, the Netherlands; 4 University Medical Center Utrecht, the Netherlands; 5 Leiden University Medical Center, the Netherlands; 6 Julius Center, University Medical Center, the Netherlands; 7 University Medical Center Groningen, the Netherlands; 8 University of Twente, the Netherlands; 9 Radboud University Medical Center, the Netherlands; 10 Academic Medical Center Amsterdam, the Netherlands. Publisher Copyright: © The European Society of Cardiology 2020. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
(Peer reviewed)