Jackie K Patterson, University of North Carolina at Chapel Hill
Simon Neuwahl, RTI International
Norman Goco, RTI International
Janet Moore, RTI International
Shivaprasad S Goudar, KLE University
Richard Derman, Thomas Jefferson UniversityFollow
Matthew Hoffman, Christiana Care
Mrityunjay Metgud, KLE University
Manjunath Somannavar, KLE University
Avinash Kavi, KLE University
Jean Okitawutshu, University of Kinshasa
Adrien Lokangaka, University of Kinshasa
Antoinette Tshefu, University of Kinshasa
Carl L Bose, University of North Carolina at Chapel Hill
Abigail Mwapule, University Teaching Hospital
Musaku Mwenechanya, University Teaching Hospital
Elwyn Chomba, University Teaching Hospital
Waldemar A Carlo, University Of Alabama At Birmingham
Javier Chicuy, Instituto de Nutrición de Centro América y Panamá
Lester Figueroa, Instituto de Nutrición de Centro América y Panamá
Nancy F Krebs, University of Colorado
Saleem Jessani, Aga Khan University
Sarah Saleem, Aga Khan University
Robert L Goldenberg, Columbia University
Kunal Kurhe, Nagpur & Datta Meghe Institute of Medical Sciences
Prabir Das, Nagpur & Datta Meghe Institute of Medical Sciences
Archana Patel, Nagpur & Datta Meghe Institute of Medical Sciences
Patricia L Hibberd, Boston University
Emmah Achieng, Moi University
Paul Nyongesa, Moi University
Fabian Esamai, Moi University
Sherri Bucher, Indiana University
Edward A Liechty, Indiana University
Brian W Bresnahan, University of Washington
Marion Koso-Thomas, National Institutes of Health
Elizabeth M McClure, RTI International

Document Type


Publication Date



This article is the author’s final published version in Volume 11, Issue 3, March 2023, Pages e436-e444.

The published version is available at Copyright © Patterson et al.


Background: Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries.

Methods: In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In this analysis from a health-care sector perspective, we considered the costs and effects of LDA treatment, pregnancy outcomes, and neonatal health-care use. We did sensitivity analyses to understand the effect of the price of the LDA regimen, and the effectiveness of LDA in reducing both preterm birth and perinatal death.

Findings: In model simulations, LDA was associated with 141 averted preterm births, 74 averted perinatal deaths, and 31 averted hospitalisations per 10 000 pregnancies. The reduction in hospitalisation resulted in a cost of US$248 per averted preterm birth, $471 per averted perinatal death, and $15·95 per disability-adjusted life year.

Interpretation: LDA treatment in nulliparous, singleton pregnancies is a low-cost, effective treatment to reduce preterm birth and perinatal death. The low cost per disability-adjusted life year averted strengthens the evidence in support of prioritising the implementation of LDA in publicly funded health care in low-income and middle-income countries.

Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID