Episode Details

A century-old pill, given to the right people, could cost-effectively save many lives.

Summary

• Targeting low-cost prevention toward people at elevated risk may uncover highly cost-effective ways to address noncommunicable diseases. Hypertensive disorders in pregnancy could be a test case for this approach.
• Meta-analyses indicate that low-dose aspirin reduces perinatal death by ~20% when given to women at risk of preeclampsia, a pregnancy complication involving high blood pressure. Aspirin likely also provides other benefits to mothers and babies, and the World Health Organization recommends this treatment for women at moderate or high risk.
• Safety evidence is reassuring but incomplete. Serious harms appear uncommon, although small increases in specific maternal morbidities may occur.
• India illustrates a large evidence-to-practice gap. Aspirin is inexpensive and early antenatal care is common, yet limited studies suggest that many higher-risk women are not treated. Observational implementation studies suggest that integrating screening, treatment, and follow-up can substantially improve uptake.
• My basic model suggests that a program driving uptake of low-dose aspirin among high-risk pregnant women could meet GiveWell's funding bar if its total cost, including screening and delivery, is roughly 32 dollars or less per high-risk pregnancy treated. That target looks feasible when compared to available benchmarks.
• This intervention [...]

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Outline:

(00:19) Summary

(02:07) Background

(03:17) The evidence on aspirin and preeclampsia

(05:55) A large evidence-to-practice gap in low- and middle-income countries

(08:09) Cost-effectiveness BOTEC

(08:13) A hypothetical program

(10:03) "Break-even" cost-effectiveness

(12:23) Recommendations

(15:48) Disclosures and Disclaimers

The original text contained 9 footnotes which were omitted from this narration.

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First published:
September 22nd, 2026

Source:
https://forum.effectivealtruism.org/posts/hJjegLxKddyiJFZ2T/targeting-high-risk-pregnancies-a-cost-effectiveness-case

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Narrated by TYPE III AUDIO.