How many of your grandparents take a baby aspirin a day? I'd bet a whole lot of them do. Now, how many of your friends took a baby aspirin a day during pregnancy? Probably not a whole lot of them. Recent research has shown that an aspirin a day can help with two of the most common and problematic complications of pregnancy: preeclampsia and preterm birth. Preeclampsia is a disease that occurs only in the second half of pregnancy and involves high blood pressure. If it progresses, the disease can lead to damage to organs like the liver and kidneys and even seizures (known as eclampsia) and death. Preterm birth is any delivery before 37 weeks and causes many of the most serious complications suffered by newborns.
Dr. Werner, Dr. Hauspurg, and Dr. Rouse from Brown University published an illuminating article in the December 2015 Green Journal exploring the cost side of aspirin for preventing preeclampsia. They compared four different plans: No prophylaxis, ACOG’s recommended approach, USPSTF’s approach, and universal prophylaxis. The authors assumed women would take one baby aspiring (81mg) a day, starting after their first prenatal appointment until they delivered.
The hardest part of this kind of research is figuring out what percent of all the women in the US would qualify for each of these approaches and how many would benefit from aspirin. The authors searched the medical literature and government databases to come up with estimates. Truth be told, they had to do some fancy footwork, but they were careful to try to prevent any overestimates. The following chart summarizes their estimates of how many women would be at high, moderate, and low risk of preeclampsia according to the guidelines and how many of these women would develop preeclampsia or preterm birth.
Now on to the money side of the calculations. The authors examined the costs of risks of taking aspirin (like gastrointestinal bleeding, aspirin-exacerbated respiratory disease, placental abruption), the cost of treating a pregnancy complicated by preeclampsia versus not ($3,408 more), cost of aspirin ($5), and preterm birth for the first year (but not neonatal death). The past data show that young women would not be at increased risk of complications from taking aspirin, but the authors wanted to be as comprehensive and un-biased as possible, so they included them. The authors also conducted sensitivity analyses, meaning that they allowed all of these estimates to vary over a range so they could tell if variation in their estimates changes their findings.
The authors found some stunning cost savings. The ACOG plan doesn’t include many women, so their plan did not save a lot of money. But, the USPSTF would prevent 14,040 cases of preeclampsia as well as many preterm births, leading to over $350 million in savings compared to no prophylaxis. Universal prophylaxis was more cost saving than the ACOG approach, but less cost saving than the USPSTF approach. The below table shows the findings.
Remember those complicated sensitivity analyses? They did thousands of sensitivity analyses and in 99% of the simulations, the USPSTF approach was still cost effective. So, even if the estimates were a little off, the USPSTF approach remains cost effective.
Over 37,000 women have participated in trials that showed a health benefit to taking aspirin for preeclampsia prophylaxis and no harms. All that remained was to show that the financials worked out. All in all, this new cost analysis provides a strong argument from a health policy perspective to institute the USPSTF approach to aspirin prophylaxis for preeclampsia.