Key points from the evidence

NICE guidance on PlGF-based testing to help diagnose suspected preterm pre-eclampsia (published in July 2022) has been adapted for NHSScotland. The NICE guidance was appraised, and no barriers to use relating to relevance, reliability and transferability of the evidence were identified.

1. Based on a review of the evidence, in terms of clinical effectiveness, NICE concluded that the use of PlGF-based tests to rule in and rule out preterm pre-eclampsia have the potential to reduce time to diagnosis, reduce maternal adverse outcomes, and improve decisions about care.
2. The economic evaluation by NICE reported that PlGF-based tests are cost effective, providing more quality-adjusted life years (QALYs) at lower costs when compared with standard assessment. This is achieved through a reduction in the resource impact of false negative diagnoses, and by the avoidance of unnecessary hospital admissions in people who can be safely managed out of hospital. PlGF-based tests remained cost effective in all the modelled scenarios. The extent of cost savings and improvement to outcomes varied depending on the evidence used to model the effectiveness of standard assessment and how test results affect clinical decision making.
3. NICE recommends four PlGF-based tests. The decision on tests to use in NHSScotland should be made locally within each health board. This will depend on factors such as the existing analysers, geography and cost. NICE do not recommend any test over another.
4. The diagnosis of pre-eclampsia may be made based on the onset of new significant sustained hypertension and proteinuria alone. PlGF-based testing is likely to be most useful in pregnant people when the diagnosis of preterm pre-eclampsia is less clear.