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La utilidad de costo del diagnóstico prenatal y el umbral basado en el riesgo
Ryan A Harris1, A Eugene Washington, Robert F Nease
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Lancet (London, England)
|January 31, 2004
Resumen
Las directrices actuales de pruebas de diagnóstico prenatal recomiendan procedimientos invasivos solo para embarazos de alto riesgo. Sin embargo, este estudio muestra que la amniocentesis y el muestreo de vellosidades coriónicas son rentables para todas las mujeres embarazadas, independientemente de la edad o los factores de riesgo.
Área de la Ciencia:
- Economía médica La economía médica.
- Diagnóstico prenatal y diagnóstico prenatal.
- Genética La genética.
Sus antecedentes:
- Las directrices actuales ofrecen el diagnóstico prenatal invasivo (amniocentesis, muestreo de vellosidades coriónicas) a mujeres mayores de 35 años o con alto riesgo de anomalías cromosómicas.
- El umbral de edad de 35 años se basó en análisis de costo-beneficio de los años 70 en los EE.UU.
- El estudio reevalúa la validez económica de los umbrales basados en la edad y el riesgo para las pruebas prenatales invasivas.
Objetivo del estudio:
- Evaluar la rentabilidad de los umbrales actuales para ofrecer un diagnóstico prenatal invasivo.
- Para determinar si la edad o el nivel de riesgo debe dictar el acceso a las pruebas de diagnóstico prenatal.
Principales métodos:
- Un análisis de costo-utilidad que compara las pruebas invasivas (muestreo de vellosidades coriónicas, amniocentesis) con las pruebas no invasivas.
- Se utilizaron datos de ensayos aleatorios, registros de casos y una evaluación de la utilidad de 534 mujeres embarazadas (de 16 a 47 años).
Principales resultados:
- Las pruebas prenatales invasivas, específicamente la amniocentesis, son rentables (menos de $ 15,000 por año de vida ajustado por calidad ganado) para mujeres de todas las edades y niveles de riesgo en los EE.
- La relación costo-utilidad es independiente de la edad materna o el riesgo de síndrome de Down.
- La relación costo-utilidad individual está influenciada por las preferencias de la paciente para la tranquilidad fetal y la tolerancia al riesgo de aborto espontáneo.
Conclusiones:
- Las pruebas de diagnóstico prenatal, incluida la amniocentesis y el muestreo de vellosidades coriónicas, son económicamente viables para todas las mujeres embarazadas.
- Las directrices actuales deben revisarse para ofrecer pruebas prenatales invasivas a todas las mujeres, independientemente de un umbral de riesgo predefinido.
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