中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
5期
325-330
,共6页
林胜谋%陈敏%王晨虹%李胜利%谢健生%袁晖%林鼎浩%吴晓霞%王威
林勝謀%陳敏%王晨虹%李勝利%謝健生%袁暉%林鼎浩%吳曉霞%王威
림성모%진민%왕신홍%리성리%사건생%원휘%림정호%오효하%왕위
唐氏综合征%妊娠初期%普查%费用效益分析
唐氏綜閤徵%妊娠初期%普查%費用效益分析
당씨종합정%임신초기%보사%비용효익분석
Down syndrome%Pregnancy trimester,first%Mass screening%Cost-benefit analysis
目的 探讨早孕期唐氏综合征(DS)各种筛查方案的功效、安全性及卫生经济学特征.方法 回顾性分析2009年1月至2012年12月在深圳市妇幼保健院接受3种传统早孕期DS筛查的43 729例孕妇的资料,其中:(1)血清学筛查17 502例,于孕11～13周+6进行,检测项目为妊娠相关血浆蛋白A(PAPP-A)+游离β-hCG水平;(2)超声筛查胎儿颈部透明层厚度(NT)14 080例;(3)联合筛查12 147例,检测NT+ PAPP-A+游离β-hCG.与同期在深圳华大基因研究院接受无创性胎儿染色体非整倍体检测技术(NIFTY)检测的孕妇7 389例,通过“决策树”模型,模拟评估4种不同筛查方案的功效和安全性;通过成本效果分析和成本效益分析,比较各筛查方案的卫生经济学特征.结果 (1)功效:4种筛查方案的筛查功效为NIFTY＞联合筛查＞NT筛查＞血清学筛查;(2)安全性:4种筛查方案的安全性为NIFTY＞联合筛查＞NT筛查＞血清学筛查;(3)成本效果分析与成本效益分析:血清学筛查的成本效果比最低,为248 686元,成本效益比最高,为4.42;传统的3种筛查方案的增量成本效果比均＜ DS患儿的疾病经济负担(1 100 000元).NIFTY筛查的成本效果比最高,为1 306 566元,成本效益净现值为负值.如果NIFTY筛查的价格降至＜1 434元,则成本效益净现值为正值,且成本效益比将＞1.结论 传统早孕期DS筛查方案中联合筛查的筛查功效最高,血清学筛查最具经济性;NIFTY筛查是DS筛查的未来发展方向.
目的 探討早孕期唐氏綜閤徵(DS)各種篩查方案的功效、安全性及衛生經濟學特徵.方法 迴顧性分析2009年1月至2012年12月在深圳市婦幼保健院接受3種傳統早孕期DS篩查的43 729例孕婦的資料,其中:(1)血清學篩查17 502例,于孕11～13週+6進行,檢測項目為妊娠相關血漿蛋白A(PAPP-A)+遊離β-hCG水平;(2)超聲篩查胎兒頸部透明層厚度(NT)14 080例;(3)聯閤篩查12 147例,檢測NT+ PAPP-A+遊離β-hCG.與同期在深圳華大基因研究院接受無創性胎兒染色體非整倍體檢測技術(NIFTY)檢測的孕婦7 389例,通過“決策樹”模型,模擬評估4種不同篩查方案的功效和安全性;通過成本效果分析和成本效益分析,比較各篩查方案的衛生經濟學特徵.結果 (1)功效:4種篩查方案的篩查功效為NIFTY＞聯閤篩查＞NT篩查＞血清學篩查;(2)安全性:4種篩查方案的安全性為NIFTY＞聯閤篩查＞NT篩查＞血清學篩查;(3)成本效果分析與成本效益分析:血清學篩查的成本效果比最低,為248 686元,成本效益比最高,為4.42;傳統的3種篩查方案的增量成本效果比均＜ DS患兒的疾病經濟負擔(1 100 000元).NIFTY篩查的成本效果比最高,為1 306 566元,成本效益淨現值為負值.如果NIFTY篩查的價格降至＜1 434元,則成本效益淨現值為正值,且成本效益比將＞1.結論 傳統早孕期DS篩查方案中聯閤篩查的篩查功效最高,血清學篩查最具經濟性;NIFTY篩查是DS篩查的未來髮展方嚮.
목적 탐토조잉기당씨종합정(DS)각충사사방안적공효、안전성급위생경제학특정.방법 회고성분석2009년1월지2012년12월재심수시부유보건원접수3충전통조잉기DS사사적43 729례잉부적자료,기중:(1)혈청학사사17 502례,우잉11～13주+6진행,검측항목위임신상관혈장단백A(PAPP-A)+유리β-hCG수평;(2)초성사사태인경부투명층후도(NT)14 080례;(3)연합사사12 147례,검측NT+ PAPP-A+유리β-hCG.여동기재심수화대기인연구원접수무창성태인염색체비정배체검측기술(NIFTY)검측적잉부7 389례,통과“결책수”모형,모의평고4충불동사사방안적공효화안전성;통과성본효과분석화성본효익분석,비교각사사방안적위생경제학특정.결과 (1)공효:4충사사방안적사사공효위NIFTY＞연합사사＞NT사사＞혈청학사사;(2)안전성:4충사사방안적안전성위NIFTY＞연합사사＞NT사사＞혈청학사사;(3)성본효과분석여성본효익분석:혈청학사사적성본효과비최저,위248 686원,성본효익비최고,위4.42;전통적3충사사방안적증량성본효과비균＜ DS환인적질병경제부담(1 100 000원).NIFTY사사적성본효과비최고,위1 306 566원,성본효익정현치위부치.여과NIFTY사사적개격강지＜1 434원,칙성본효익정현치위정치,차성본효익비장＞1.결론 전통조잉기DS사사방안중연합사사적사사공효최고,혈청학사사최구경제성;NIFTY사사시DS사사적미래발전방향.
Objective To investigate the effects,safety and cost-benefit analysis of Down syndrome screening in first trimester.Methods From January 2009 to December 2012,43 729 pregnant women undergoing 3 methods of Down syndrome traditional screening strategies in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively,including in 17 502 cases in pregnancy associated plasma protein A (PAPP-A) and free β-hCG measured biochemistry screening,14 080 cases in nuchal translucency (NT) screening and 12 147 cases in combined screening,meanwhile,7 389 cases on non-invasive fetal trisomy test (NIFTY) were performed in Huada Gene Research Institute(BGI).The effects and safety of four screening strategies were assessed throughout a decision tree.The economical characters of each screening strategy were compared by cost-effectiveness analysis as well as cost-benefit analysis.Results (1) The effects of four strategies are:NIFTY ＞ combined screening ＞ NT screening ＞ biochemistry screening.(2) The safety of four strategies are:NIFTY ＞ combined screening ＞ NT screening ＞ biochemistry screening.(3) Cost-effectiveness analysis and cost-benefit analysis:the biochemistry screening has lowest cost-effectiveness ratio (CER) and highest cost-benefit ratio (CBR),which performed a bettereconomical efficiency.The incremental CER of three traditional screening strategies are all less than the economical burden of Down syndrome.NIFTY has highest CER and negative net present value (NPV),NPV would be positive and CBR would be more than 1 if the price of NIFTY reduce to 1 434 Yuan.Conclusions Combined screening possess best screening efficiency,while biochemistry screening was demonstrated more economical in traditional screening.NIFTY is the future of Down syndrome screening.
