産前診断のコスト・ユーティリティとリスクベースの値
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
まとめ
現在の産前診断検査ガイドラインでは,高リスク妊娠の場合のみ,侵襲的処置を推奨しています. しかし,この研究では,乳液縮と胆管の採取は,年齢やリスク要因に関係なく,すべての妊婦にとって費用対効果が高いことが示されています.
科学分野:
- 医学経済学 医学経済学
- 産前診断術 産前診断術
- 遺伝学 遺伝学とは
背景:
- 現在のガイドラインでは,35歳以上の女性,または染色体異常のリスクが高い女性に対して,侵襲的な産前診断 (アミオセンテシス,胆採取) を提案しています.
- 35歳という年齢制限は,1970年代の米国でのコスト・ベネフィット分析に基づいていた.
- この研究では,侵襲的産前検査の年齢およびリスクに基づく値の経済的妥当性を再評価しています.
研究 の 目的:
- 侵襲的産前診断を提供するための現在の値の費用対効果を評価する.
- 年齢やリスクレベルが,産前診断検査へのアクセスを決定すべきかどうかを判断する.
主な方法:
- 侵襲的な検査 (胆管の採取,乳芽切開) と非侵襲的な検査を比較したコスト・ユーティリティ分析.
- ランダム化試験,症例登録,および534人の妊婦 (16歳~47歳) の有用性評価から得られたデータを活用した.
主要な成果:
- 侵襲的産前検査,特に乳房芽切開は,米国のすべての年齢およびリスクレベルの女性にとって費用対効果が高く (品質調整された1年当たり15,000ドル未満).
- コスト・ユーティリティは,母親の年齢やダウン症候群のリスクとは無関係です.
- 個人のコスト・ユーティリティは,胎児の安心と流産リスクに対する耐性に対する患者の好みによって影響を受けます.
結論:
- アンニオセントーシスと胆管の採取を含む産前診断検査は,すべての妊婦にとって経済的に有効です.
- 現在のガイドラインは,事前に定義されたリスクの値に関係なく,すべての女性に侵入性産前検査を提供するように見直されるべきです.
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