Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA.
J Matern Fetal Neonatal Med. 2021 Feb;34(4):526-531. doi: 10.1080/14767058.2019.1610734. Epub 2019 May 2.
Eisenmenger syndrome (ES) is regarded as a contraindication to pregnancy, with therapeutic abortion recommended in the event of unintended pregnancy. However, women with ES continue to desire and attempt pregnancy despite grave risks to their own health. This study compares the costs and outcomes of pregnancy in women with ES to the use of gestational surrogates in their pregnancies. A decision-analytic model was built using TreeAge software that compared use of gestational surrogates and pregnancy in women with ES. Maternal death and neonatal outcomes including intrauterine fetal demise, preterm birth, cerebral palsy, and death were assessed. All probabilities and costs were derived from the literature. Utilities were discounted at a rate of 3% across the expected lifespan to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to evaluate the robustness of the model given changes in baseline assumptions. In a theoretical cohort of 1000 women with ES, pregnancy would result in 360 maternal deaths, 100 stillbirths, 477 preterm births, and 157 neonatal deaths . In these highly desired pregnancies, use of gestational surrogates would prevent 99 and 98% of maternal and neonatal death, respectively. Cases and costs of preterm birth and associated cerebral palsy are also significantly reduced. Use of a gestational surrogate would save $518,255 per woman with a gain of 6.77 QALYs, a dominant strategy. The approach is cost-effective up to a cost of surrogacy of $1.2 million and even if the surrogate achieves pregnancy only 30% of the time. The use of surrogate mothers for those with ES is cost-effective and results in significantly improved maternal and neonatal outcomes. These benefits are robust in the face of high surrogacy costs largely due to the marked reduction in maternal mortality and preterm birth. These findings should be used to underscore the importance of broadening health care financing for medically-indicated assisted reproduction.
艾森曼格综合征（Eisenmenger syndrome，ES）被认为是妊娠的禁忌证，如果意外怀孕，建议进行治疗性流产。然而，尽管存在严重的健康风险，患有 ES 的女性仍继续渴望并尝试怀孕。本研究比较了 ES 女性妊娠和使用妊娠代孕的成本和结局。使用 TreeAge 软件构建了一个决策分析模型，比较了妊娠代孕和 ES 女性妊娠的使用。评估了母婴死亡和新生儿结局，包括宫内胎儿死亡、早产、脑瘫和死亡。所有概率和成本均来自文献。效用以预期寿命的 3%贴现率贴现，以生成质量调整生命年（QALYs）。进行了单变量和多变量敏感性分析，以评估模型在基线假设变化时的稳健性。在 1000 名 ES 女性的理论队列中，妊娠将导致 360 例母亲死亡、100 例死产、477 例早产和 157 例新生儿死亡。在这些高度期望的妊娠中，使用妊娠代孕将分别预防 99%和 98%的母亲和新生儿死亡。早产及其相关脑瘫的病例和成本也显著降低。每位女性使用妊娠代孕将节省 518255 美元，获得 6.77 个 QALYs，是一种优势策略。这种方法在代孕成本达到 120 万美元以下是具有成本效益的，即使代孕仅 30%的时间能成功怀孕。对于 ES 患者来说，使用代孕母亲是具有成本效益的，可显著改善母婴结局。这些益处是稳健的，即使代孕成本很高，主要是由于母亲死亡率和早产率显著降低。这些发现应被用来强调扩大医疗指示性辅助生殖的医疗保健融资的重要性。
