Background: Pre-eclampsia (PE) affects approximately 2-4% of pregnancies. Diagnosis involves repeated assessment of pregnant patients with risk factors. The sFlt-1/PlGF ratio test is shown to have clinical utility in ruling in and out PE among at-risk patients. By excluding the probability of PE, the addition of the sFlt-1/PlGF ratio test to antenatal care, may prevent unnecessary hospital admissions, intensive management, and premature delivery, thus reducing costs. Objectives: A systematic review to determine the cost-effectiveness of the sFlt-1/PlGF ratio test globally for pregnant patients at-risk of developing PE. Search Strategy: PubMed, Medline (OVID), National Health Service Economic Evaluation Database, Web of Science, Econlit, and Cost Effectiveness Analysis Registry searched between 2013-April 2023. Selection Criteria: Empirical studies quantifying costs of the sFlt-1/PlGF ratio test compared to other treatment options for patients with suspected PE. Data collection and Analysis: Eleven studies were included; all were cost analyses and modelled economic evaluations, and most used a health system perspective. Cost data were extracted and indexed to 2022 United States Dollars (USD). Main results: All studies reported “cost-savings” of the test in antenatal care. Studies varied with costs and assumptions included, therefore a large range of incremental cost savings per patient was reported ($15-$1,881, 2022USD). No Incremental Cost-Effectiveness Ratios or health outcomes including Quality Adjusted Life Years were reported. Conclusions: The included studies demonstrated “cost-savings” of the sFlt-1/PlGF ratio test in antenatal care for at-risk pregnant patients. However, this does not account for health outcome differences and long-term health care utilisation and expenditure. Funding: Nil