(974) RNA-based screening for preterm preeclampsia reduces costs in pregnancies of advanced maternal age

The objective of this study is to estimate the economic impact of introducing a ribonucleic acid (RNA)-based risk assessment for preterm preeclampsia (Encompass™, Mirvie) in pregnant individuals of advanced maternal age (AMA; ≥35 years) with no high risk factors for preeclampsia compared to the current United States Preventive Services Task Force (USPSTF) guideline-based screening.

Study Design:

Using the Merative® MarketScan Commercial Claims and Encounters Database (01/01/2019 to 12/31/2023), the mean net maternal-infant payments were quantified in AMA pregnancies with ≥1 moderate preeclampsia risk factor, stratified by preeclampsia status and gestational age (< 28, 28-33, 34-36, and ≥37 weeks of gestational age). Payments included costs incurred from 6 months pre-delivery to 12 months post-delivery. A US payer-focused budget impact analysis incorporated screening and treatment costs (low-dose aspirin and remote blood pressure monitoring) to compare projected expenditures under RNA-based risk assessment-guided care versus USPSTF-based care. All costs were reported in 2025 US Dollars.

Results:

Pregnancies with individuals with AMA complicated by preeclampsia incurred substantially higher total costs compared with those without preeclampsia ($2.4 M versus $704 K at < 28 weeks). Additionally, earlier deliveries had a larger cost differential than at-term deliveries. Incorporating RNA-based risk assessment into routine care resulted in gross medical cost savings of $5,678 per pregnancy with AMA screened (or $5.7 M per 1,000 persons). Cost savings were driven by reductions in severe and early deliveries requiring intensive neonatal care.

Conclusion:

The implementation of the RNA-based risk assessment for preterm preeclampsia among individuals with AMA may result in cost savings from the payer perspective. These savings are primarily attributable to targeted interventions and shifts in gestational age at delivery to later stages of pregnancy.