Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
Acta Obstet Gynecol Scand. 2011 Jul;90(7):772-8. doi: 10.1111/j.1600-0412.2011.01138.x. Epub 2011 May 20.
To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only.
Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG.
Obstetric departments of three academic and six general hospitals in The Netherlands. Population. Laboring women with a singleton high-risk pregnancy, a fetus in cephalic presentation, a gestational age >36 weeks and an indication for internal electronic fetal monitoring.
A trial-based cost-effectiveness analysis was performed from a health-care provider perspective.
Primary health outcome was the incidence of metabolic acidosis measured in the umbilical artery. Direct medical costs were estimated from start of labor to childbirth. Cost-effectiveness was expressed as costs to prevent one case of metabolic acidosis.
The incidence of metabolic acidosis was 0.7% in the ST-analysis group and 1.0% in the CTG-only group (relative risk 0.70; 95% confidence interval 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST analysis (n= 2 827) were €1,345 vs. €1,316 for CTG only (n= 2 840), with a mean difference of €29 (95% confidence interval -€9 to €77) until childbirth. The incremental costs of ST analysis to prevent one case of metabolic acidosis were €9 667.
The additional costs of monitoring by ST analysis of the fetal ECG are very limited when compared with monitoring by CTG only and very low compared with the total costs of delivery.
评估与单独使用胎儿心电图（ECG）的心电描记图（CTG）相比，在分娩期间对胎儿进行监测时添加胎儿心电图 ST 分析（STAN）的成本效益。
基于胎儿心电图 ST 分析的随机临床试验的成本效益分析。
荷兰三家学术医院和六家综合医院的产科病房。人群：具有高危单胎妊娠、头位、胎龄>36 周和宫内电子胎儿监测指征的产妇。
从医疗保健提供者的角度进行基于试验的成本效益分析。
主要健康结果是通过脐动脉测量的代谢性酸中毒发生率。直接医疗费用是从分娩开始到分娩结束估算的。成本效益用预防一例代谢性酸中毒的成本来表示。
ST 分析组代谢性酸中毒的发生率为 0.7%，CTG 组为 1.0%（相对风险 0.70；95%置信区间 0.38-1.28）。每例分娩，CTG 加 ST 分析（n=2827）的平均每位患者费用为 1345 欧元，而仅 CTG（n=2840）的平均费用为 1316 欧元，平均差异为 29 欧元（95%置信区间 -9 至 77 欧元）直到分娩。为预防一例代谢性酸中毒，ST 分析的增量成本为 9667 欧元。
与单独使用 CTG 相比，监测胎儿心电图 ST 分析的额外成本非常有限，与分娩的总成本相比非常低。
