Londoño Trujillo Darío, Castro García Paula A, Rojas López Kristian K, Moreno-Medina Karen J, Dominguez Torres María T, Dennis Verano Rodolfo J, Sandoval Reyes Nestor F
Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
J Health Econ Outcomes Res. 2024 May 23;11(1):141-148. doi: 10.36469/001c.116147. eCollection 2024.
Congenital heart disease is the most common congenital condition worldwide, with a prevalence of 80 cases per 10 000 live births. In addition to perinatal morbidity and mortality, it entails long-term consequences such as multiple surgeries, prolonged hospitalizations, lifelong cardiac follow-up, reduced quality of life, risk of heart failure, and premature mortality in adulthood. This significant health and economic burden on healthcare systems and families highlights the relevance of evaluating the cost-effectiveness of methods for early detection of this condition. To conduct a systematic literature review (SLR) to identify and analyze existing economic evaluations on prenatal detection of congenital heart diseases through ultrasound, focusing on the reported cost-effectiveness results and the methodological quality of the evaluated studies according to established criteria. An SLR of economic evaluations was conducted following PRISMA guidelines. A quantitative synthesis of key methodological components of each economic evaluation was performed. The incremental medical costs, effectiveness measures, and cost-effectiveness ratios reported in each study were compiled and compared. The methodological quality was assessed according to compliance with the 24 CHEERS criteria. We found 785 articles, of which only 7 met all inclusion criteria. Most were cost-effectiveness analyses, with the most common outcome being number of cases detected. Screening with only 4-chamber views interpreted by general practitioners or cardiologists were dominant strategies compared with screening with 4-chamber plus outflow views interpreted by a general practitioner. Fetal echocardiography was most effective but most expensive. Screening with 4-chamber and outflow view, followed by referral to a specialist, were recommended as the least expensive strategy per defect detected. On average, articles met 17 of the 24 CHEERS criteria. While recent cost-effectiveness analyses demonstrated improved methodological quality, there was a lack of homogeneity due to differences in comparators and population subgroups analyzed. Despite this heterogeneity, fetal ultrasonography screening was consistently identified as a cost-effective strategy, with its cost-effectiveness heavily influenced by the expertise of the interpreting physician. Most studies recommend implementing obstetric ultrasonography screening, without routine fetal echocardiography, for detecting congenital heart diseases.
先天性心脏病是全球最常见的先天性疾病，每10000例活产儿中患病率为80例。除围产期发病率和死亡率外，它还会带来长期后果，如多次手术、长期住院、终身心脏随访、生活质量下降、心力衰竭风险以及成年期过早死亡。这种对医疗系统和家庭造成的巨大健康和经济负担凸显了评估该疾病早期检测方法成本效益的重要性。进行系统文献综述（SLR），以识别和分析通过超声对先天性心脏病进行产前检测的现有经济评估，重点关注根据既定标准报告的成本效益结果和评估研究的方法学质量。按照PRISMA指南进行了经济评估的SLR。对每项经济评估的关键方法学组成部分进行了定量综合。汇总并比较了每项研究报告的增量医疗成本、效果指标和成本效益比。根据是否符合24条CHEERS标准评估方法学质量。我们发现了785篇文章，其中只有7篇符合所有纳入标准。大多数是成本效益分析，最常见的结果是检测到的病例数。与由全科医生解读四腔心切面加流出道切面进行筛查相比，仅由全科医生或心脏病专家解读四腔心切面进行筛查是主要策略。胎儿超声心动图最有效但最昂贵。推荐采用四腔心和流出道切面筛查，然后转诊至专科医生，作为每检测到一个缺陷成本最低的策略。平均而言，文章符合24条CHEERS标准中的17条。虽然最近的成本效益分析显示方法学质量有所提高，但由于所分析的比较对象和人群亚组存在差异，缺乏同质性。尽管存在这种异质性，胎儿超声筛查一直被认为是一种具有成本效益的策略，其成本效益受解读医生专业知识的严重影响。大多数研究建议实施产科超声筛查，而不进行常规胎儿超声心动图检查，以检测先天性心脏病。
