高龄孕妇对2种不同唐氏产前诊断方案的需求及经济学评价

目的:探讨高龄孕妇对2种不同唐氏产前诊断方案的需求,并对这2种方案进行经济学评价。方法:选择2015年3月1日至2016年3月31日孕20+6周前在深圳市妇幼保健院产科就诊的单胎高龄孕妇4104例,由孕妇自主选择先行无创胎儿DNA检测(NIPT),NIPT高风险再行羊膜腔穿刺(方案1)或直接羊膜腔穿刺(方案2)。比较孕妇对2种方案的需求及其影响因素,并对2种方案进行经济学评价。结果:选择方案1的比率明显高于方案2[51.34%(2107/4104)vs 7.65%(314/4104),χ~2=1883.431,P0.001]。Logistic回归分析显示,孕妇年龄、传统唐氏筛查结果和胎儿颈部透明层厚度(NT)是影响孕妇选择的因素。与方案2相比,方案1可以节省67.21%的总费用。结论:高龄孕妇对NIPT有巨大的需求,且高龄孕妇采用NIPT筛查阳性后再行羊膜腔穿刺术可节省医疗费用,建议在充分知情同意的基础上可将NIPT用于高龄孕妇的一线筛查,尤其是适用于年龄较轻、传统唐氏筛查非高风险、NT正常的高龄孕妇。

The demand and economic evaluation of two strategies for Down syndrome prenatal diagnosis in pregnant women with advanced maternal age

Objective:To explore the demand of two options for Down syndrome prena-tal diagnosis in pregnant women with advanced maternal age,we did perform economic evalua-tion of two options. Methods:From March 12015 to March 312016,a total of 4104 singleton pregnant women of advanced maternal age who required outpatient before 20+6 weeks of gesta-tion at Shenzhen Maternity and Child Healthcare Hospital were recruited for this study. Women were asked to choose between strategy 1 ( NIPT as the initial screening,amniocentesis if positive result from NIPT) and strategy 2 ( universal amniocentesis) . The demand and influencing fac-tors of two strategies were compared,and economic evaluation of two strategies were also per-formed. Results:The percentage of women choosing strategy 1 was higher than that of women choosing strategy 2[51. 34%(2107/4104)vs 7. 65%(314/4104),X2=1883. 431,P<0. 001], and Logistic regression analysis showed that maternal age, the result of traditional Down syn-drome screening and nuchal translucency ( NT) were influencing factors. Strategy 1 could save 67 . 21% costs compared with strategy 2 . Conclusion:There is great demand for NIPT in preg-nant women of advanced maternal age. Moreover,amniocentesis for the women with positive re-sult from NIPT can save medical costs. After detail counseling,pregnant women of advanced ma-ternal age can be offered NIPT as the initial screening,especially in women with younger age, non-high risk for traditional Down syndrome screening and normal NT.