Doyle L W, Murton L J, Kitchen W H
Department of Obstetrics and Gynaecology, University of Melbourne, Parkville.
Med J Aust. 1989 May 15;150(10):558-63, 567-8. doi: 10.5694/j.1326-5377.1989.tb136693.x.
In one tertiary perinatal centre, the advent of positive-pressure assisted ventilation in the 1970s improved the survival of neonates of 24 to 28 completed weeks of gestation. However, the rate of increase in the resources for assisted ventilation and the improvements in survival rates were stepwise and not smooth. Consequently, it has been possible to calculate the cost-effectiveness of neonatal intensive care up to the time of hospital discharge over two separate eras of stable consumption of resources for assisted ventilation. During 1977-1983, to produce one survivor at 24-weeks' gestation compared with one at 28-weeks' gestation consumed 14.4-times the number of patient-days of assisted ventilation, and 4.9-times more of the total nursery resources; the cost-effectiveness of intensive care during this period decreased with decreasing maturity. The over-all cost-effectiveness up to the time of hospital discharge for infants of 24- to 28-weeks' gestation during 1977-1983, compared with 1971-1974, when assisted ventilation was rare, was $62,268 per additional survivor. After 1983, the consumption of resources for assisted ventilation more than doubled in infants of 24- to 28-weeks' gestation. However, there was a diminishing return with respect to the gains in survival during 1984-1986 and the costs per additional survivor averaged $99,574, which was 60% more than were those for 1977-1983. We speculate that to improve survival further in the most-immature infants by increasing resources for assisted ventilation only can be more difficult and more expensive, and even less cost-effective.
在一家三级围产期中心，20世纪70年代正压辅助通气的出现提高了孕24至28周新生儿的存活率。然而，辅助通气资源的增加速度和存活率的提高是逐步的，并不平稳。因此，在辅助通气资源消耗稳定的两个不同时期，有可能计算出直至出院时新生儿重症监护的成本效益。在1977 - 1983年期间，与孕28周的新生儿相比，要使一名孕24周的新生儿存活，辅助通气的患者天数消耗是其14.4倍，总保育资源消耗是其4.9倍；在此期间，重症监护的成本效益随着成熟度降低而下降。与1971 - 1974年（当时辅助通气很少见）相比，1977 - 1983年期间孕24至28周婴儿直至出院时的总体成本效益为每增加一名存活者62,268美元。1983年之后，孕24至28周婴儿的辅助通气资源消耗增加了一倍多。然而，在1984 - 1986年期间，存活率的提高带来的回报逐渐减少，每增加一名存活者的成本平均为99,574美元，比1977 - 1983年高出60%。我们推测，仅通过增加辅助通气资源来进一步提高最不成熟婴儿的存活率可能会更加困难和昂贵，甚至成本效益更低。
