Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
Birth Defects Res. 2017 Mar 1;109(4):262-270. doi: 10.1002/bdra.23608. Epub 2017 Feb 13.
The impact of prenatal diagnosis of d-transposition of the great arteries (dTGA) on health-care usage is largely unknown. We evaluated a population-based cohort to assess costs, mortality and inpatient encounters by whether dTGA was prenatally diagnosed or not.
The dTGA cases (born 1997-2011) identified at the Utah Birth Defect Network, which includes data on timing of diagnosis, were linked to statewide inpatient discharge data. We excluded preterm cases or cases with additional major heart defects. We evaluated hospitalizations and costs for infants (first year of life) and mothers (10 months before birth) using multivariable models adjusted for demographic and clinical risk factors.
Of 119 cases, 14 (12%) were prenatally diagnosed. Birth weight, surgical complexity and extracardiac defects/syndromes were similar between groups. Of 7 deaths (6%), two occurred pre-intervention in postnatally diagnosed infants. Prenatal diagnosis was associated with more in-hospital days (estimate 13 additional days, p = 0.03) and higher mean costs for mothers ($4,141 vs $12,148) and infants (90,419 vs $49,576). Prenatal diagnosis independently predicted higher adjusted costs for the overall cohort ($22,570, p = 0.045). After excluding deaths, total costs were no longer significantly different.
Mothers of prenatally diagnosed infants with dTGA had higher inpatient costs compared with those postnatally diagnosed. Costs trended higher for their infants, although were not significantly different. Linkage of population-based surveillance systems and outcome databases can be a powerful tool to further explore the complex relationship of prenatal diagnosis to costs and outcomes in other types of congenital heart diseases. Birth Defects Research 109:262-270, 2017. © 2017 Wiley Periodicals, Inc.
产前诊断右室双出口（dTGA）对医疗保健使用的影响在很大程度上是未知的。我们评估了一个基于人群的队列，以评估是否通过产前诊断 dTGA 来评估成本、死亡率和住院患者遭遇。
在犹他州出生缺陷网络中确定了 dTGA 病例（1997-2011 年出生），该网络包括诊断时间的数据，并与全州住院患者出院数据相关联。我们排除了早产儿或有其他主要心脏缺陷的病例。我们使用多变量模型评估了婴儿（生命的第一年）和母亲（出生前 10 个月）的住院和费用，该模型调整了人口统计学和临床危险因素。
在 119 例病例中，有 14 例（12%）为产前诊断。两组间的出生体重、手术复杂性和心脏外缺陷/综合征相似。7 例死亡（6%）中有 2 例发生在产后诊断的婴儿中。产前诊断与更多的住院天数（估计增加 13 天，p=0.03）和母亲（4141 美元与 12148 美元）和婴儿（90419 美元与 49576 美元）的平均费用更高有关。产前诊断可独立预测整个队列的调整后费用更高（22570 美元，p=0.045）。排除死亡后，总费用不再有显著差异。
与产后诊断的 dTGA 婴儿的母亲相比，产前诊断婴儿的母亲住院费用更高。尽管婴儿的费用呈上升趋势，但差异无统计学意义。人群监测系统和结果数据库的链接可以成为进一步探讨产前诊断与其他类型先天性心脏病成本和结果之间复杂关系的有力工具。出生缺陷研究 109:262-270, 2017。©2017 年 Wiley 期刊，Inc.
