Cost-effectiveness and implications of newborn screening for prolongation of QT interval for the prevention of sudden infant death syndrome.
Cost-effectiveness and implications of newborn screening for prolongation of QT interval for the prevention of sudden infant death syndrome.
复制标题
新生儿筛查延长 QT 间期以预防婴儿猝死综合症的成本效益和影响。
DOI：
10.1016/s0022-3476(00)90011-8
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Berul,CI
中科院分区：
文献类型：
--
作者：
Zupancic,JA;Triedman,JK;Alexander,M;Walsh,EP;Richardson,DK;Berul,CI
目的确定成本效益的普遍和高危新生儿心电图（ECG）筛查QT间期延长的预测婴儿猝死综合征（SIDS）的风险在一个理论组news.Study designIncremental成本效益分析与决策分析模型。建立了一个健康足月儿的假设队列，比较了无筛查、高危新生儿筛查和普遍筛查的选择。高风险策略是推测性的，因为目前还没有公认的方法来识别婴儿猝死综合征的高风险婴儿。鉴于校正QT间期（QTc）延长与SIDS之间的相关机制不确定，在不同假设下重复分析。敏感性分析也进行了所有输入变量的成本和effectiveness.ResultsUnder的假设，即新生儿心电图筛查检测长QT综合征响应于常规治疗，高风险筛查的成本效益为3403 perlifeyeargained，whereasuniversalscreeningcost 18,465每增加生命年获得。然而，如果SIDS治疗的有效性下降到福尔斯10%以下，那么高风险策略的成本效益就会恶化到每生命年节省28，376美元，而普遍筛查的成本效益就会恶化到每生命年节省118，900美元。的分析是强大的一个广泛的阵列的敏感性analysis.ConclusionsThe新生儿心电图筛查的成本效益的可接受性在很大程度上取决于小岛屿发展中国家的病理生理机制和监测和抗抑郁治疗的疗效。在常规新生儿心电图筛查之前，必须阐明这种关联的性质。
ObjectiveTo determine the cost-effectiveness of universal and high-risk neonatal electrocardiographic (ECG) screening for QT prolongation as a predictor of sudden infant death syndrome (SIDS) risk in a theoretical group of neonates.Study designIncremental cost-effectiveness analysis with decision analytic modeling. A hypothetical cohort of healthy, term infants was modeled, comparing options of no screening, high-risk neonate screening, and universal screening. The high-risk strategy is speculative, because no currently accepted methodology is known for identifying infants at high risk for SIDS. Given the uncertain mechanisms of association between prolonged corrected QT interval (QTc) and SIDS, analyses were repeated under different assumptions. Sensitivity analyses were also performed on all input variables for both costs and effectiveness.ResultsUnder the assumption that neonatal electrocardiographic screening detects long QT syndrome responsive to conventional therapy, the cost-effectiveness of high-risk screening was 3403perlifeyeargained,whereasuniversalscreeningcost 18,465 per additional life year gained. However, if the effectiveness of SIDS therapy falls below 10%, the cost-effectiveness deteriorates to 28,376perlifeyearsavedforthehigh-riskstrategyand 118,900 for universal screening. The analyses were robust to a broad array of sensitivity analyses.ConclusionsThe acceptability of the cost-effectiveness of neonatal electrocardiographic screening is heavily dependent on the pathophysiologic mechanism of SIDS and on the efficacy of monitoring and antiarrhythmic treatment. The nature of this association must be elucidated before routine neonatal electrocardiographic screening is warranted.