Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
RTI International, Research Triangle Park, NC, USA.
Lancet Glob Health. 2023 Mar;11(3):e436-e444. doi: 10.1016/S2214-109X(22)00548-4.
Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries.
In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In this analysis from a health-care sector perspective, we considered the costs and effects of LDA treatment, pregnancy outcomes, and neonatal health-care use. We did sensitivity analyses to understand the effect of the price of the LDA regimen, and the effectiveness of LDA in reducing both preterm birth and perinatal death.
In model simulations, LDA was associated with 141 averted preterm births, 74 averted perinatal deaths, and 31 averted hospitalisations per 10 000 pregnancies. The reduction in hospitalisation resulted in a cost of US$248 per averted preterm birth, $471 per averted perinatal death, and $15·95 per disability-adjusted life year.
LDA treatment in nulliparous, singleton pregnancies is a low-cost, effective treatment to reduce preterm birth and perinatal death. The low cost per disability-adjusted life year averted strengthens the evidence in support of prioritising the implementation of LDA in publicly funded health care in low-income and middle-income countries.
Eunice Kennedy Shriver National Institute of Child Health and Human Development.
早产与死亡率和发病率增加相关，预防早产的策略数量有限且资源密集。2020 年，ASPIRIN 试验表明，低剂量阿司匹林（LDA）对预防早产在初产妇、单胎妊娠中有效。我们旨在研究这种疗法在中低收入国家的成本效益。
在这项事后、前瞻性、成本效益研究中，我们构建了一个概率决策树模型，以比较 LDA 治疗与标准护理在使用初级数据和 ASPIRIN 试验发表结果的情况下的效益和成本。在这项从医疗保健部门角度进行的分析中，我们考虑了 LDA 治疗、妊娠结局和新生儿医疗保健使用的成本和效果。我们进行了敏感性分析，以了解 LDA 方案价格和 LDA 降低早产和围产儿死亡的效果的影响。
在模型模拟中，LDA 与每 10000 例妊娠中避免 141 例早产、避免 74 例围产儿死亡和避免 31 例住院相关。由于住院治疗减少，避免每例早产的成本为 248 美元，避免每例围产儿死亡的成本为 471 美元，避免每例残疾调整生命年的成本为 15.95 美元。
LDA 治疗初产妇、单胎妊娠是一种低成本、有效的治疗方法，可以降低早产和围产儿死亡。避免每例残疾调整生命年的低成本进一步支持了在中低收入国家将 LDA 纳入公共资助的卫生保健系统的优先事项的证据。
美国国立儿童健康与人类发育研究所 Eunice Kennedy Shriver 。
