Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico
Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico
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DOI：
10.1371/journal.pmed.1000379
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发表时间：
2010-12-01
期刊：
影响因子：
15.8
通讯作者：
Salomon, Joshua A.
中科院分区：
文献类型：
--
作者：
Profit, Jochen;Lee, Diana;Salomon, Joshua A.
背景：新生儿重症监护可以提高存活率，但与高成本和幸存者的残疾有关。墨西哥最近的卫生改革启动了一项新的补贴保险计划，要求对该计划可能涵盖的不同干预措施（包括新生儿重症监护）做出知情选择。本研究的目的是估计的临床结果，成本和成本效益的新生儿重症监护在Mexico.Methods和调查结果：一个成本效益分析进行了使用决策分析模型的健康和经济结果早产。根据墨西哥生命登记和出院数据库估计了控制健康结局的模型参数，并补充了来自已发表文献的荟萃分析和系统综述。费用估算依据的是墨西哥卫生部提供的数据和世界卫生组织的价目表，并根据需要辅之以其他国家发表的研究报告。该模型估计了与无重症监护相比，新生儿重症监护的临床结局、预期寿命、无残疾预期寿命、终身成本、残疾调整生命年（DDEs）和增量成本效益比（ICER）的变化。使用单向敏感性分析和多变量概率敏感性分析来表征结果的不确定性。在基础病例分析中，胎龄24-26周、27-29周和30-33周出生的新生儿重症监护可延长预期寿命28年、43年和34年，并避免了9年、15年和12年的死亡，每名婴儿的增量成本分别为11，400美元、9，500美元和3，000美元，相比之下，没有重症监护。新生儿重症监护在24-26周、27-29周和30-33周的ICER分别为1，200美元、650美元和240美元/DALY。结果是强大的变化参数值在很宽的范围内的敏感性analysis.Conclusions：增量成本效益比新生儿重症监护意味着非常高的价值的基础上，传统的基准成本效益分析。
Background: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.Methods and Findings: A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses.Conclusions: Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis.