唐氏综合征产前筛查策略的成本效益和准确性：联合检测是否应继续广泛应用？

Cost-effectiveness and accuracy of prenatal Down syndrome screening strategies: should the combined test continue to be widely used?

机构信息

Laboratoire de Simulations des Dépistages, Unité de Diagnostic Prénatal, Service de Génétique Médicale, Québec City, Québec, Canada.

出版信息

Am J Obstet Gynecol. 2011 Feb;204(2):175.e1-8. doi: 10.1016/j.ajog.2010.09.017. Epub 2010 Nov 11.

DOI:10.1016/j.ajog.2010.09.017

PMID:21074138

Abstract

OBJECTIVE

We analyzed the cost-effectiveness (CE) and performances of commonly used prenatal Down syndrome (DS) screening strategies.

STUDY DESIGN

We performed computer simulations to compare 8 screening options by applying empirical data from Serum, Urine, and Ultrasound Screening Study trials on the population of 110,948 pregnancies. Screening strategies outcomes, CE ratios, and incremental CE ratios were measured.

RESULTS

The most CE DS screening strategy was the contingent screening method (CE ratio of Can$26,833 per DS case). Its incremental CE ratio compared to the second-most CE strategy (serum integrated screening) was Can$3815 per DS birth detected. Among the procedures respecting guidelines, our results identified the combined test as the screening strategy with the highest CE ratio (Can$47,358) and the highest number of procedure-related euploid miscarriages (n = 71).

CONCLUSION

In regard to CE, contingent screening is the best choice. The combined test, which is the most popular screening strategy, shows many limitations.

摘要

目的

我们分析了常用的产前唐氏综合征（DS）筛查策略的成本效益（CE）和表现。

研究设计

我们通过应用来自血清、尿液和超声筛查研究试验的经验数据，对 110948 例妊娠的人群进行了计算机模拟，比较了 8 种筛查方案。测量了筛查策略的结果、CE 比值和增量 CE 比值。

结果

最符合 CE 的 DS 筛查策略是条件性筛查方法（每例 DS 病例的 CE 比值为加元 26833 ）。与第二大 CE 策略（血清综合筛查）相比，其增量 CE 比值为每例 DS 出生增加 3815 加元。在符合指南的程序中，我们的结果确定联合检测是 CE 比值最高（加元 47358）和与程序相关的整倍体流产数量最多（n=71）的筛查策略。