产前诊断的成本效益和基于风险的门
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
概括
目前的产前诊断测试指南仅在高风险怀孕中推侵入性手术. 然而,这项研究表明,乳液化和胆囊取样本对于所有孕妇来说都是具有成本效益的,无论年龄或风险因素如何.
科学领域:
- 医学经济学 医学经济学
- 产前诊断 在产前诊断
- 遗传学 遗传学 是一个
背景情况:
- 目前的指导方针为35岁以上或染色体异常高风险的女性提供侵袭性产前诊断 (阴膜切割,胆取样).
- 35岁的年龄门是基于美国1970年代的成本效益分析.
- 该研究重新评估了侵袭性产前检测的年龄和基于风险的门的经济有效性.
研究的目的:
- 评估目前提供侵入性产前诊断的门的成本效益.
- 确定年龄或风险水平是否应该决定获得产前诊断测试.
主要方法:
- 一个成本效益分析,比较侵入性测试 (胆道取样,羊水切割) 与非侵入性测试.
- 利用了来自随机试验,病例注册和对534名孕妇 (16-47岁) 的实用性评估的数据.
主要成果:
- 在美国,侵袭性产前检测,特别是乳液切割,对于所有年龄和风险水平的女性来说都是具有成本效益的 (每获得的质量调整寿命年低于15,000美元).
- 成本效益是独立于母亲的年龄或唐氏综合征风险.
- 个体的成本效益受患者对胎儿安慰的偏好和对流产风险的容忍度的影响.
结论:
- 产前诊断检测,包括羊切片和胆毛样本采集,对于所有孕妇来说都是经济可行的.
- 目前的指导方针应该被修订,为所有妇女提供侵入性产前检测,而不管预先定义的风险值.
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