Cost-effectiveness analysis of a model of first-trimester prediction and prevention of preterm pre-eclampsia compared with usual care.

OBJECTIVES: Pre-eclampsia (PE) causes substantial maternal and neonatal mortality and morbidity. In addition to the personal impact on women, children and their families, PE has a significant economic impact on our society. Recent research suggests that a first-trimester multivariate model is highly predictive of preterm (< 37 weeks' gestation) PE and can be combined successfully with targeted prophylaxis (low-dose aspirin), resulting in an 80% reduction in prevalence of disease. The aim of this study was to examine the potential health outcomes and cost implications following introduction of first-trimester prediction and prevention of preterm PE within a public healthcare setting, compared with usual care, and to conduct a cost-effectiveness analysis to inform health-service decisions regarding implementation of such a program. METHODS: A decision-analytic model was used to compare usual care with the proposed first-trimester screening intervention within the obstetric population (n = 6822) attending two public hospitals within a metropolitan district health service in New South Wales, Australia, between January 2015 and December 2016. The model, applied from early pregnancy, included exposure to a variety of healthcare professionals and addressed type of risk assessment (usual care or first-trimester screening) and use of (compliance with) low-dose aspirin prescribed prophylactically for prevention of PE. All pathways culminated in six possible health outcomes, ranging from no PE to maternal death. Results were presented as the number of cases of PE gained/avoided and the incremental increase/decrease in economic costs arising from the intervention compared with usual care. Significant assumptions were tested in sensitivity/uncertainty analyses. RESULTS: The intervention produced, across all gestational ages, 31 fewer cases of PE and reduced aggregate economic health-service costs by 1 431 186 Australian dollars over the 2-year period. None of the tested iterations of uncertainty analyses reported additional cases of PE or higher economic costs. The new intervention based on first-trimester screening dominated usual care. CONCLUSION: This cost-effectiveness analysis demonstrated a reduction in prevalence of preterm PE and substantial cost savings associated with a population-based program of first-trimester prediction and prevention of PE, and supports implementation of such a policy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Trace minerals in commercially prepared baby foods.

Five categories of strained baby foods were analyzed for iron, copper, zinc, magnesium, manganese, strontium, and cadmium. Meats, egg yolk, and cerals tended to have the highest concentrations of iron, copper, and zinc. Fruits and vegetables had lower contents of these minerals. Cereals and vegetables were the best sources of magnesium and manganese. Strontium and cadmium levels were consistently low.

Hair analysis of trace minerals in human subjects as influenced by age, sex, and contraceptive drugs.

Eleven male and 16 female residents of Tucson, Arizona volunteered blood and hair samples and dietary information. Hair and blood samples were analyzed for zinc, copper, magnesium, and iron. Dietary records were calculated for the same. Female subjects had a higher mean hair zinc level than male subjects, but serum zinc was not different for the two groups and mean dietary zinc intake was greater for males. The only difference observed with age was a decrease in hair zinc level over 50 years of age. The taking of oral contraceptives resulted in mean hair copper level numerically decreased while serum copper increased. Mean hair zinc increased with contraceptive use and serum zinc decreased. Mean dietary intakes of copper and zinc were not different between nonpregnant control women and women taking oral contraceptives. For human subjects, mineral concentration of hair, serum, and diet do not correlate well, emphasizing that influencing factors and must be considered in interpreting hair analysis results.

Evaluation of hair analysis for determination of zinc status using rats.

Weanling male and female Sprague-Dawley rats were fed diets of graded levels of dietary zinc from 3 to 68 ppm. The zinc concentrations of hair, bone, and testes reflected the dietary intake by increasing with each increment of dietary zinc. Kidney zinc indicated the state of zinc metabolism by declining on restricted intakes and remaining constant above the requirement level. Plasma and liver zinc concentrations and enzyme activities were not related to dietary intake nor were any significant changes observed with restricted zinc intakes. Hair zinc levels decreased more rapidly with dietary zinc levels below the zinc requirement. Therefore, hair zinc analysis can be used to aid in diagnosis of a deficiency or evaluate dietary intake for the rat but can not be used to assess the state of zinc metabolism.