Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Faculty of Economics, Chiang Mai University, Chiang Mai, Thailand.
BMC Health Serv Res. 2019 Nov 27;19(1):898. doi: 10.1186/s12913-019-4699-4.
To identify the most cost-beneficial model as a national policy of screening and diagnosis of fetal Down syndrome (DS) in developing countries.
Cost-benefit analysis (CBA) was performed based on the effectiveness and probabilities derived from a large prospective study on MSS (maternal serum screening) among Thai population. Various models including maternal age alone, STS (second trimester screen), I-S (independent screen: first or second trimester screen depending on the time of first visit), C-S (contingent serum screen) plus STS, maternal age with NIPS (non-invasive prenatal test), STS alone with NIPS, I-S with NIPS, C-S plus STS with NIPS, and Universal NIPS were compared.
I-S with NIPS as a secondary screening was most cost-beneficial (Benefit/Cost ratio 4.28). Cost-benefit is directly related to the costs of NIPS.
In addition to simplicity and feasibility, I-S with expensive NIPS as a secondary screening is the most cost-beneficial method for low resource settings and should be included in universal healthcare coverage as a national policy. This study could be a model for developing countries or a guideline for international health organizations to help low resource countries, probably leading to a paradigm shift in prenatal diagnosis of fetal DS in the developing world.
为了确定在发展中国家作为胎儿唐氏综合征（DS）筛查和诊断的国家政策的最具成本效益的模式。
基于对泰国人群进行的大规模前瞻性 MSS（母体血清筛查）研究的有效性和概率，进行成本效益分析（CBA）。比较了各种模型，包括单独的母亲年龄、STS（中期筛查）、I-S（独立筛查：根据首次就诊时间选择第一或中期筛查）、C-S（随诊血清筛查）加 STS、母亲年龄加 NIPS（非侵入性产前检测）、单独的 STS 加 NIPS、I-S 加 NIPS、C-S 加 STS 加 NIPS，以及通用 NIPS。
作为二级筛查的 I-S 加 NIPS 最具成本效益（效益/成本比为 4.28）。成本效益与 NIPS 的成本直接相关。
除了简单性和可行性之外，昂贵的 NIPS 作为二级筛查的 I-S 是最具成本效益的方法，适用于资源有限的环境，并应作为国家政策纳入全民医疗保健覆盖范围。本研究可以为发展中国家提供一个模型，或者为国际卫生组织提供一个指导方针，以帮助资源有限的国家，可能会导致发展中国家胎儿 DS 产前诊断的范式转变。
