Am J Perinatol 2021; 38(04): 363-369
DOI: 10.1055/s-0039-1697588
Original Article

The Impact of the New Hypertension Guidelines to Low-Dose Aspirin Prophylaxis Eligibility for the Prevention of Preeclampsia: A Cost-Benefit Analysis

Manesha Putra
1   Department of Reproductive Biology, MetroHealth Medical Center, Cleveland, Ohio
2   Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
3   Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio
Madagedara Maduka Balasooriya
4   Department of Industrials and System Engineering, Wayne State University, Detroit, Michigan
Alexander L. Boscia
3   Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio
Evrim Dalkiran
4   Department of Industrials and System Engineering, Wayne State University, Detroit, Michigan
Robert J. Sokol
5   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
› Author Affiliations
Funding None.


Objective American College of Cardiology and American Heart Association (ACC/AHA) published new guidelines which lower the cut-off for hypertension. We sought to evaluate the impact of these guidelines to cost and benefit of various low-dose aspirin prophylaxis approaches.

Study Design Decision tree analysis was created using R software to evaluate four approaches to aspirin prophylaxis in the United States: no aspirin, United States Preventive Service Task Force (USPSTF) with Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) hypertension guidelines, USPSTF with ACC/AHA hypertension guidelines, as well as universal aspirin prophylaxis. This model was executed to simulate a hypothetical cohort of 4 million pregnant women in the United States.

Results The new guidelines would expand the aspirin eligibility by 8% (76,953 women) in the USPSTF guidelines. Even with this increased eligibility, the USPSTF guidelines continue to be the approach with the most cost savings ($386.5 million) when compared with universal aspirin and no aspirin prophylaxis. The new hypertension guidelines are projected to increase the cost savings of the USPSTF approach by $9.4 million.

Conclusion Despite the small change in aspirin prophylaxis, using ACC/AHA definition of hypertension still results in an annual cost-saving of $9.4 million in the United States when compared with JNC7.


Part of this paper was presented at the Society for Maternal Fetal Medicine Meeting 39th Annual Pregnancy Meeting, February 11 to 16, Las Vegas, NV.

Supplementary Material

Publication History

Received: 24 March 2019

Accepted: 12 August 2019

Article published online:
11 October 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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