>>Top Belgian hospital to offer pre-eclampsia screening free of charge

ASPRE News

Following presentation of the ground-breaking ASPRE study results, one of the pioneers in the screening of pre-eclampsia, Brugmann University Hospital, Brussels, Belgium, has decided not to wait for an eventual decision on reimbursement, but to offer free of charge pre-eclampsia screening to its patients right away. Professor Jacques Jani, head of the department of Obstetrics and Gynecology provides some background on screening of pre-eclampsia at Brugmann University Hospital.

PlGF (Placental Growth Factor) is an excellent marker for pre-eclampsia and can also improve the performance of Trisomy 21 screening. By running clinical studies and using Research and Development funds, we have integrated this test in our clinical practice to fulfil our obligations to provide risk assessment for Trisomy 21 while also allowing risk assessment for pre-eclampsia.

Up to now there has been no provision for the reimbursement of pre-eclampsia screening in Belgium. The delay with this has resulted because there is no official laboratory test code for biochemical
pre-eclampsia screening markers, and a dossier needs to be prepared for the NIHDI (Belgium's National Institute for Health and Disability Insurance). We are actively occupied in preparing such a reimbursement dossier and hope this will make the PIGF test accessible to all pregnant women in our country and also that other countries will adopt a similar policy.

In 2017, Belgium decided to offer NIPT as an alternative to biochemistry screening for Trisomy 21. Had we been able to continue with running biochemistry for the screening of Trisomy 21, the test would have indirectly served for the screening of pre-eclampsia while the reimbursement dossier is prepared and processed. In daily practice, though, the patients to whom we explain the test performance of a NIPT test compared to biochemical tests for the screening of Trisomy 21 naturally choose the NIPT test and not the biochemical standard. Only a minority of patients are then ready to pay out-of-pocket the cost of the biochemical tests for pre-eclampsia - approximately 70,00 EUR. We have already experienced this during the last two weeks.

The main question is: will we able to convince gynecologists of the importance of this screening for pre-eclampsia? In fact, the ASPRE study proves that 62% of the preterm pre-eclampsia cases can be prevented in patients screened as high risk. A secondary analysis proves that if we exclude the patients suffering with known chronic blood pressure, compliance with the aspirin therapy (150mg) allows eradication of preterm pre-eclampsia in 90% of the cases.

Confronted with these spectacular results and knowing that approximately 2,000 to 5,000 of the pregnant women in Belgium will develop pre-eclampsia, of which a hundred will be treated at Brugmann University Hospital, we decided that from now on we will offer our patients screening for pre-eclampsia free of charge, along with treatment if they turn out to be high risk.

:: ASPRE :: Professor Jani played a key role in the European Union funded randomized controlled trial : combined multimarker screening and randomised patient treatment with ASpirin for evidence based PREeclampsia prevention (ASPRE).

Source : ASPRE Project News (issue 2, october 2017)