Symptom-free women at increased risk of ectopic pregnancy: should we screen?
Symptom-free women at increased risk of ectopic pregnancy: should we screen?
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DOI：
10.1034/j.1600-0412.2002.810713.x
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发表时间：
2002-07-01
影响因子：
4.3
通讯作者：
Bossuyt, PMM
中科院分区：
文献类型：
--
作者：
Mol, BWJ;van der Veen, F;Bossuyt, PMM
背景资料。经阴道超声、血清绒毛膜促性腺激素(HCG)测定和血清孕酮测定提供了筛查无症状、增加异位妊娠风险的妇女的可能性。本研究的目的是通过分析异位妊娠筛查的预期收益和成本，评估异位妊娠筛查的成本-效果。将经阴道超声检查、血清hCG测定和血清孕酮测定相结合的筛查方案与“警惕等待”策略进行比较。数据摘自文献。在预防输卵管破裂的预期数量、预期的假阳性诊断数量和预期的成本方面对这些策略进行了比较。筛查的成本效益似乎强烈依赖于异位妊娠的流行率。在宫外孕患病率为6%的情况下，采用经阴道超声和血清hCG检测的筛查程序将使每100名筛查妇女中破裂异位妊娠的患者数量从2.1人减少到0.61人。每个预防的输卵管破裂预计筛查费用约为933欧元，而每个预防的输卵管破裂预期的假阳性诊断数为0.64。我们的结论是，对异位妊娠进行筛查可以减少输卵管破裂患者的数量，但前提是假阳性率很高。尽管对有宫外孕风险的无症状妇女进行超声检查可能出于心理原因而是合理的，但这种政策的医疗和经济利益似乎是有限的。
Background. Transvaginal sonography, serum human chorionic gonadotrophin (hCG) measurement, and serum progesterone measurement provide the possibility to screen symptom-free women at increased risk of ectopic pregnancy. The objective of the present study was to evaluate the cost-effectiveness of screening for ectopic pregnancy, by addressing the expected benefits and costs of screening for ectopic pregnancy.Methods. Screening programs incorporating transvaginal sonography, serum hCG measurement, and serum progesterone measurement were compared with a 'watchful waiting' strategy. Data were extracted from the literature. The strategies were compared on the expected number of prevented tubal ruptures, the expected number of false-positive diagnoses, and expected costs.Results. The cost-effectiveness of screening appeared to be strongly dependent on the prevalence of ectopic pregnancy. At a prevalence of ectopic pregnancy of 6%, a screening program with transvaginal sonography and serum hCG measurement would reduce the number of patients with ruptured ectopic pregnancy from 2.1 to 0.61 per 100 screened women. Screening was expected to cost approximately Euro 933 per prevented tubal rupture, whereas the number of expected false-positive diagnoses was 0.64 per prevented tubal rupture.Conclusion. We conclude that screening for ectopic pregnancy reduces the number of patients with tubal rupture, but only at the expense of a large false-positive rate. Although sonography in symptom-free women at risk of ectopic pregnancy might be justified for psychological reasons, the medical and economic benefits of such a policy seem to be limited.