产前诊断预防唐氏综合征策略的经济学评价

目的:评估我国产前诊断预防唐氏综合征的成本—效果和成本—效益,为决策者和医疗服务供方提供循证信息。方法:在查阅文献和对4个城市的现场调查基础上,从社会角度,对产前诊断预防唐氏综合征策略进行经济学评估。结果:在目前临床水平下,在10000名孕妇队列中对35岁以上高风险人群直接行羊膜腔穿刺产前诊断的策略(年龄筛查策略)能筛出0.67个唐氏综合征病例;而采用外周血两联筛查(AFP HCG),对阳性者再行羊膜腔穿刺的产前诊断策略(孕母血筛查策略)能筛出1.39个病例。孕妇年龄筛查策略和孕母血筛查策略预防1例唐氏综合征的成本分别为107582.09元和469328.46元,效益成本比分别为4.22和1.00。敏感性分析显示降低孕母血筛查成本、提高筛查覆盖率和羊膜腔穿刺产前诊断接受率能使孕母血筛查策略更有成本效果。结论:从国际经验看,孕母血筛查策略比年龄筛查策略更具成本效果。但在我国,由于孕母血筛查策略的低覆盖率、羊膜腔穿刺产前诊断接受率低和孕母血筛查的较高价格导致孕母血筛查策略并不更经济。有关技术应用的卫生系统因素是技术实施效率的重要影响因素。

Economic Evaluation of Prenatal Diagnosis Intervention for Down''''s Syndrome in China

Objectives: To assess the cost-effectiveness and cost-benefit of prenatal diagnosis intervention for Down's syndrome(DS)in China and provide evidence-based information to policy makers and providers. Methods: Based on field surveys in 4 selected cities in China and literature review, the economic evaluation of prenatal diagnosis for DS from a societal perspective is conducted by cost-effectiveness analysis, cost-benefit analysis and sensitivity analysis. Results: In current clinical practice, for a cohort of 10,000 pregnant women, the strategy which delivers karyotyping by chorionic villus sampling(CVS)or amniocentesis(AC)only to those aged 35 and above pregnant women(maternal age screening strategy) can detect 0.67 DS births. The strategy which offers the diagnostic test after maternal serum screening with AFP and hCG double test (maternal serum screening strategy) can detect 1.39 DS births. The cost per prevented DS birth by the maternal age screening strategy and maternal serum screening strategy is 107 582 Yuan and 469 328 Yuan, respectively. The benefit-cost ratio is 4.22 for the maternal age screening strategy and 1.00 for the maternal serum screening strategy. Sensitivity analysis shows that the maternal serum screening strategy can be cost-effective if the intervention coverage and uptake rate of CVS or AC for patients with positive serum tests increase while the cost of serum screening decreases. Conclusion: Though, in general, serum screening has been found to be more cost-effective than screening based only on maternal age, this appears not to be the case in China. The reasons appear to be China's low coverage of the maternal serum strategy, low uptake rate of CVS or AC and the high price of serum screening. Our findings are that health system factors concerning technology utilization are important determinants of the technology's efficiency.