Campbell Helen E, Karim Jehan N, Papageorghiou Aris T, Wilson Edward C F, Rivero-Arias Oliver
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
BJOG. 2025 Apr;132(5):638-647. doi: 10.1111/1471-0528.18053. Epub 2025 Jan 21.
To assess the cost-effectiveness of modifying current antenatal screening by adding first trimester structural anomaly screening to standard of care second trimester anomaly screening.
Health economic decision model.
National Health Service (NHS) in England and Wales.
Pregnant women attending for first trimester antenatal screening.
The decision model estimated pregnancy outcomes (maternal and foetal) and 20-year costs for current screening practice and for a policy adding a protocol screening for eight major structural anomalies to the current first trimester ultrasound scan. Event probabilities, costs, and outcomes for the model were informed by meta-analyses, published literature, and expert opinion.
Expected numbers of pregnancy outcomes, healthcare costs, and maternal quality-adjusted life years (QALYs). Estimation of the incremental cost-effectiveness ratio (ICER), likelihood of cost-effectiveness, and a value of information (VoI) analysis assessing if further research is needed before making a decision about screening.
First trimester anomaly screening increased mean per woman costs by £11 (95% CI £1-£29) and maternal QALYs by 0.002065 (95% CI 0.00056-0.00358). The ICER was £5270 per QALY and the probability of cost-effectiveness at a willingness to pay value for a QALY of £20 000, exceeded 95%. VoI analysis showed further research would be unlikely to represent value for money. The protocol would likely lead to a reduction in infant healthcare costs and QALYs.
A protocol to screen for eight major structural anomalies during the first trimester appears to represent value for money for the NHS. The opposing implications for mothers and infants, however, raise complex, challenging, and sensitive issues.
通过在标准的孕中期异常筛查基础上增加孕早期结构异常筛查，评估改进当前产前筛查的成本效益。
健康经济决策模型。
英格兰和威尔士的国民医疗服务体系（NHS）。
接受孕早期产前筛查的孕妇。
该决策模型估计了当前筛查实践以及在当前孕早期超声扫描基础上增加八项主要结构异常方案筛查的政策下的妊娠结局（母体和胎儿）及20年成本。模型的事件概率、成本和结局通过荟萃分析、已发表文献和专家意见得出。
妊娠结局的预期数量、医疗保健成本以及母体质量调整生命年（QALY）。估计增量成本效益比（ICER）、成本效益可能性以及信息价值（VoI）分析，以评估在做出筛查决策前是否需要进一步研究。
孕早期异常筛查使每位女性的平均成本增加了11英镑（95%置信区间为1 - 29英镑），母体QALY增加了0.002065（95%置信区间为0.00056 - 0.00358）。ICER为每QALY 5270英镑，在愿意为一个QALY支付20000英镑的情况下，成本效益概率超过95%。VoI分析表明进一步研究不太可能具有成本效益。该方案可能会降低婴儿医疗保健成本和QALY。
在孕早期筛查八项主要结构异常的方案对NHS而言似乎具有成本效益。然而，对母亲和婴儿的相反影响引发了复杂、具有挑战性和敏感的问题。
