Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Acta Obstet Gynecol Scand. 2019 Aug;98(8):967-975. doi: 10.1111/aogs.13590. Epub 2019 Apr 4.
Perinatology, the study of two individuals that constitute the mother-fetus dyad, poses unique challenges to the conduct of clinical decision analysis (CDA) and economic evaluation (EE) studies. Our objective was systematically to review CDA and model-based EE studies in pregnant women to better understand how these studies have been conducted and reported in perinatology.
MEDLINE, Embase, Scopus, Web of Science and clinicaltrials.gov were searched as of October 2018. The indexing terms "pregnancy", "decision trees", "Markov models" and "economic models" were used. The search was limited to human data and the English language. Two reviewers independently screened titles and abstracts. Data extraction and assessment of reporting quality were performed in duplicate for 10% of studies and reached 100% agreement. The remainder was carried out by a single reviewer. The study protocol was registered with PROSPERO (CRD 42016047206).
Seventy-seven studies met eligibility criteria and fulfilled between 40% and 91% of relevant attributes on the checklist for critical appraisal of CDA models. There was considerable variation in study reporting. A total of 53% of studies included maternal and offspring outcomes, 14% described using weighted means, meta-analyses or health administrative databases to estimate probabilities and 13% considered outcomes over the lifetime of mother and offspring. Patient preferences (utilities) were used in 47% of the studies. Of these, 10% were elicited from healthcare providers alone and not from pregnant women or the public. Of the EE studies, 25% described a societal analytic perspective. Where relevant, 42% described discounting for costs and benefits, and 30% reported using probabilistic and deterministic sensitivity analyses.
Despite long-term implications of perinatal decisions to mother and offspring, CDA and model-based EE studies in perinatology frequently do not consider lifetime horizons and patient-preferences for outcomes related to mother and offspring. They also often fail to adhere to guidelines regarding conduct and reporting.
围产医学研究的是构成母亲-胎儿对子的两个人，这给临床决策分析（CDA）和经济评估（EE）研究的开展带来了独特的挑战。我们的目的是系统地回顾围产医学中进行的 CDA 和基于模型的 EE 研究，以更好地了解这些研究在围产医学中的开展和报告方式。
截至 2018 年 10 月，我们检索了 MEDLINE、Embase、Scopus、Web of Science 和 clinicaltrials.gov。使用的索引术语有“pregnancy”（妊娠）、“decision trees”（决策树）、“Markov models”（马尔可夫模型）和“economic models”（经济模型）。检索仅限于人类数据和英语语言。两位审查员独立筛选标题和摘要。10%的研究进行了重复的数据提取和报告质量评估，达到了 100%的一致性。其余的由一位审查员进行。该研究方案已在 PROSPERO（CRD 42016047206）上注册。
共有 77 项研究符合入选标准，在 CDA 模型的关键评估清单中满足了 40%至 91%的相关属性。研究报告存在很大差异。共有 53%的研究包括母婴结局，14%的研究描述了使用加权平均值、荟萃分析或健康管理数据库来估计概率，13%的研究考虑了母婴的终生结局。47%的研究使用了患者偏好（效用）。其中，10%的研究仅从医疗保健提供者那里获得，而不是从孕妇或公众那里获得。在 EE 研究中，25%的研究描述了一种全社会分析视角。在相关情况下，42%的研究描述了对成本和效益的贴现，30%的研究报告了使用概率和确定性敏感性分析。
尽管围产期决策对母婴有长期影响，但围产医学中的 CDA 和基于模型的 EE 研究往往没有考虑到母婴相关结局的终生范围和患者偏好。它们也经常不遵守关于开展和报告的指南。
