The use of magnesium sulfate to prevent seizures in the pre-eclamptic gravida: a cost-effectiveness analysis

Objective To assess the costs, and outcomes of various strategies for seizu re prophylaxis in pre-eclampsia in the United States. Methods A decision analysis model was constructed with magnesium sulfate as the anticonvulsant of choice. Three strategies were evaluated: no, anti-co nvulsant therapy; selective prophylaxis, for patients with severe pre-eclam psia; and universal prophylaxis for all patients with pre-eclampsia (severe and mild disease). Results Under baseline assumptions, selective therapy prevented 21 % of ecl amptic seizures. The estimated cost for each seizure prevented would be $33 33 and the cost for each death averted would be $166 667. Universal treatme nt would result in prevention of 35% of eclamptic seizures. The cost for ea ch seizure prevented would be $6024 and the cost for each death averted wou ld be $301 205. In a cost-effective comparison of the two magnesium sulfate treatment strategies, the incremental cost of universal prophylaxis would! be $9994 for every, additional seizure prevented and $469 000 for each add itional death averted. Conclusions The universal prophylaxis of all preeclamptic women with magnes ium sulfate appears to be cost-effective compared to the strategy of select ed treatment of only those with severe disease.