Cost and effectiveness of the California triple marker prenatal screening program
Cost and effectiveness of the California triple marker prenatal screening program
复制标题
加州三标记产前筛查计划的成本和有效性
DOI：
10.1097/00125817-199907000-00006
复制
发表时间：
1999
影响因子：
8.8
通讯作者：
D. G. Tompkinson
中科院分区：
文献类型：
--
作者：
George C Cunningham;D. G. Tompkinson
目的：报告一项独特的全州产前三重标志物筛查计划所提供的服务和妊娠结局的利用情况，并提出成本效益分析。考虑的是3200万的州人口，具有可考虑的种族和年龄分布，并具有提供产前护理的各种分娩系统。研究对象为妊娠20周前的全部孕妇，1995-1997年间每年约50万人。方法：1986-1995年间强制提供血清甲胎蛋白检测，并于1995年添加人绒毛膜促性腺激素和未结合雌三醇，并对血清筛查阳性者进行系统的超声和羊膜穿刺术随访。本研究收集和分析了项目数据和结局报告，并从出生缺陷登记中收集了类似的信息。结果：符合条件的妇女接受三重标记血清筛查的比例为67.4%，初步阳性率为7.3%。在最初筛查的阳性孕妇中，超过90%是在产前诊断中心看到的。矫正胎龄后，71.3%的孕妇进行了羊水穿刺术。在接受筛查的妇女中，总的羊膜穿刺率为2.6%。该程序对神经管缺陷的检测率预测为85%，基于蒙特卡罗模型，理论上计算出唐氏综合征的检测率为62%。在实践中，由于羊膜穿刺术接受率低于预期，神经管缺陷的检出率为75%，唐氏综合征的检出率为41%。然而，在5%的贴现率下，筛查方案的成本效益比为2.69：1。每个发现病例的成本为35365例，每个预防病例的成本为110,741例。结论：在不同种族人群中实施符合质量标准的成本效益高的人群筛查是可能的，并有不同的卫生保健提供者。即使所有服务的利用率并不理想，在妊娠中期进行三重标记筛查也是一个成本效益较高的计划。
Purpose: To report the utilization of services offered and pregnancy outcomes for a unique statewide prenatal triple marker screening program and to present a cost-benefit analysis. A state population of 32 million with consider-able ethnic and age distribution and with a wide variety of delivery systems providing prenatal care was considered. The entire pregnant population who appeared for care before 20 weeks gestation, approximately one-half million per year during the years of 1995 to 1997, was included in the study.Methods: Mandatory offering of serum testing, using alpha-fetoprotein from 1986 to 1995, and the addition of human chorionic gonadotropin and unconjugated estriol in 1995, with systematic follow-up of serum screen positives with ultrasound and amniocentesis. This study collected and analyzed the program data and reports of outcomes and collected similar information from the birth defects registry.Results: Triple marker serum screening was accepted by 67.4% of the women eligible and yielded an initial positive rate of 7.3%. More than 90% of the initially screen positive pregnancies were seen at a prenatal diagnostic center. After correction of gestational age, 71.3% had amniocentesis. The overall amniocentesis rate among women screened was 2.6%. The Program's detection rate was predicted to be 85% for neural tube defects, and, based on Monte Carlo modeling, was theoretically calculated to be 62% for Down syndrome. In practice, detection rates were 75% for neural tube defects and 41% for Down syndrome due to lower than expected amniocentesis acceptance rate. Nevertheless, at a 5% discount rate, the screening program was cost beneficial at a ratio of 2.69:1. The cost per case detected was 35,365 and per case prevented was 110,741.Conclusion: It is possible to implement a cost-effective population-based screening in compliance with quality standards in a diverse ethnic population with a variety of health-care providers. Triple marker screening in the second trimester is a cost beneficial program even if utilization of all services is less than ideal.