唐氏综合征产前筛查方案选择的成本-效果分析

目的从经济学的角度探讨适合中国国情的唐氏综合征产前筛查方案。方法运用成本效果分析,计算两联筛查和三联筛查不同检出率与假阳性率下每检出1例唐氏综合征的费用,并进行比较,费用最低方案为优选方案。结果在以医院为中心筛查情况下,在37·39%的产前诊断率时,酶联免疫法两联筛查每检出1例唐氏综合征费用在336156~845274元;时间分辨法两联筛查每检出1例唐氏综合征费用在600727~1756865元;化学发光法三联筛查每检出1例唐氏综合征费用在743756元~2404572元。结论酶联免疫法两联筛查最佳方案为方案E(检出率84·62%,假阳性率9·32%),每检出1例唐氏综合征费用最低(336156元);时间分辨法两联筛查最佳方案为方案H(检出率77·78%,假阳性率21·46%),每检出1例唐氏综合征费用最低(600727元);化学发光法三联筛查最佳方案为方案H(检出率90·91%,假阳性率6·14%),每检出1例唐氏综合征费用最低(743756元)。

A Cost- effectiveness Analysis of Prenatal Screening for Down''''s Syndrome

Objective: To find out the most economical schemes of prenatal screening for Down's syndrome. Methods: Dectection rates by the methods of double and triple screening were analysed on the basis of cost-effectiveness analysis, and the cost of per Down's syndrome founded out was calculated and compared. Results: The costs per Down's syndrome detected by methods of double-test enzyme linkedimmunsorbsent assay( ELISA), double-test time resolved fluoroisnmunoassay(TRFIA) and triple-test chemiluminesent immunoassay were336,156-845,274 RMB, 600,727-1,756,865 RMB and 743,756-2,404,572 RMB, respectively. Conclusion: The best schemes of double-test ELISA, double-test TRFIA and triple-test Chemiluminesent Immunoassay were project E, H and H, and the lowest cost of per Down's syndrome detected was 336,156 RMB, 600,727 RMB and 743,756 RMB, respectively, with 84.62%, 77.78%, 90.91% for detection rate and 9.32%, 21.46% and 6.14% for false positive rate.