探索妊娠糖尿病查的成本效益建模中的结构性不确定性:来自挪威的应用示例
Pia S Henkel1, Emily A Burger1,2, Line Sletner3
1Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
概括
在挪威,最具成本效益的妊娠糖尿病查策略有所不同,在大多数情况下,普遍查是最佳的. 需要进一步研究长期结果,以减少不确定性.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 孕产妇健康 孕产妇健康
背景情况:
- 在挪威,妊娠糖尿病 (GDM) 的查已经扩大,但最佳的资格标准仍在争论中.
- 评估成本效益对于完善GDM选策略至关重要.
研究的目的:
- 为了比较挪威四种GDM查策略的成本效益:通用,当前指南,高风险和没有查.
- 探索结构性不确定性和未来研究GDM选资格标准的价值.
主要方法:
- 开发了一个概率决策树模型来估计成本和质量调整寿命年 (QALYs).
- 评估了四种策略:通用,当前,高风险和没有查.
- 进行了情景和信息价值分析,以解决不确定性,包括对2型糖尿病 (T2DM) 和围产死亡的影响.
主要成果:
- 目前挪威的查建议在所有分析中都被发现是低效的.
- 在初级分析中,普遍查是最具成本效益的策略 (获得了26,014/QALY).
- 当假定GDM治疗对T2DM没有预防作用时,高风险查成为首选 (获得19,115/QALY).
结论:
- 最佳的GDM查策略取决于对围产死亡和T2DM的治疗效应的纳入.
- 存在很高的决策不确定性,特别是关于长期母亲的结果.
- 建议对GDM查和治疗的长期影响进行进一步的研究,以减少不确定性.
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