Expectant management of preterm premature rupture of membranes at 34 weeks: a cost effectiveness analysis.
Expectant management of preterm premature rupture of membranes at 34 weeks: a cost effectiveness analysis.
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DOI：
10.1080/14767058.2021.2017874
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发表时间：
2022-12
影响因子：
1.8
通讯作者：
Caughey, Aaron B.
中科院分区：
文献类型：
--
作者：
Powell, Jacqueline M.;Frank, Zoe C.;Clark, Grace, V;Lo, Jamie O.;Caughey, Aaron B.
关键词：
旨在检查对于 34 周时出现胎膜早破 (PPROM) 的妇女，期待治疗与立即分娩的结果和成本效益。使用 TreeAge 软件建立了一个成本效益模型，对 37,455 名 PPROM 妇女在 34 周时接受期待治疗直至 37 周与立即分娩的理论队列进行比较。结果包括胎儿死亡、新生儿败血症、新生儿死亡、新生儿神经发育迟缓、健康新生儿、孕产妇败血症、孕产妇死亡、费用和质量调整生命年。概率来自文献，成本效益阈值设定为每个质量调整生命年 100,000 美元。在我们的 37,455 名女性理论队列中，期待治疗使新生儿死亡人数减少了 58 人，新生儿神经发育迟缓病例减少了 164 人。然而，这导致新生儿败血症病例增加 407 例，孕产妇败血症病例增加 2.7 例。预期管理使质量调整生命年增加了 3,531 个，每年节省成本 7,190 万美元，使其成为主导策略。单变量敏感性分析表明，期待治疗具有成本效益，直到每周产前入院费用超过 17,536 美元（基线估计：12,520 美元）或羊膜内感染后产妇败血症的风险超过 20%。我们的模型表明，与立即分娩相比，34 周时 PPROM 的期待治疗总体上以更低的成本产生了更好的结果。鉴于最近的研究表明预期治疗可改善新生儿结局，这项分析非常重要且及时。然而，在做出这一临床决定时必须考虑个人风险和偏好，因为当产褥感染风险增加时，期待治疗可能会增加不良围产期结局的风险。
To examine the outcomes and cost effectiveness of expectant management versus immediate delivery of women who experience preterm premature rupture of membranes (PPROM) at 34 weeks. A cost-effectiveness model was built using TreeAge software to compare outcomes in a theoretical cohort of 37,455 women with PPROM at 34 weeks undergoing expectant management until 37 weeks versus immediate delivery. Outcomes included fetal death, neonatal sepsis, neonatal death, neonatal neurodevelopmental delay, healthy neonate, maternal sepsis, maternal death, cost, and quality-adjusted life years. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000 per quality-adjusted life year. In our theoretical cohort of 37,455 women, expectant management yielded 58 fewer neonatal deaths and 164 fewer cases of neonatal neurodevelopmental delay. However, it resulted in 407 more cases of neonatal sepsis and 2.7 more cases of maternal sepsis. Expectant management resulted in 3,531 more quality-adjusted life years and a cost savings of $71.9 million per year, making it a dominant strategy. Univariate sensitivity analysis demonstrated expectant management was cost effective until the weekly cost of antepartum admission exceeded $17,536 (baseline estimate: $12,520) or the risk of maternal sepsis following intraamniotic infection exceeded 20%. Our model demonstrated that expectant management of PPROM at 34 weeks yielded better outcomes on balance at a lower cost than immediate delivery. This analysis is important and timely in light of recent studies suggesting improved neonatal outcomes with expectant management. However, individual risks and preferences must be considered in making this clinical decision as expectant management may increase the risk of adverse perinatal outcomes when the risk of puerperal infection increases.
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影响因子：
7.2
作者：
Beck C;Gallagher K;Taylor LA;Goldstein JA;Mithal LB;Gernand AD
通讯作者：
Gernand AD
影响因子：
168.9
作者：
Morris, Jonathan M.;Roberts, Christine L.;Crowther, Caroline A.
通讯作者：
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DOI：
10.1097/inf.0b013e3181acf6bd
发表时间：
2009-12
期刊：
The Pediatric infectious disease journal
影响因子：
--
作者：
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通讯作者：
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影响因子：
2.3
作者：
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影响因子：
9.8
作者：
Bivins, Harold A., Jr.;McCallum, Olivia J.;Roegge, Deborah D.
通讯作者：
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