Roberts T, Mugford M, Piercy J
National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford.
Br J Obstet Gynaecol. 1998 Sep;105(9):960-70. doi: 10.1111/j.1471-0528.1998.tb10258.x.
To compare the cost effectiveness of different programmes of routine antenatal ultrasound screening to detect four key fetal anomalies: serious cardiac anomalies, spina bifida, Down's syndrome and lethal anomalies, using existing evidence.
Decision analysis was used based on the best data currently available, including expert opinion from the Royal College of Obstetricians and Gynaecologists, Working Party and secondary data from the literature, to predict the likely outcomes in terms of malformations detected by each screening programme.
Results applicable in clinics, hospitals or GP practices delivering antenatal screening.
The number of cases with a 'target' malformation correctly detected antenatally.
There was substantial overlap between the cost ranges of each screening programme demonstrating considerable uncertainty about the relative economic efficiency of alternative programmes for ultrasound screening. The cheapest, but not the most effective, screening programme consisted of one second trimester ultrasound scan. The cost per target anomaly detected (cost effectiveness) for this programme was in the range 5,000 pound silver-109,000, pound silver but in any 1000 women it will also fail to detect between 3.6 and 4.7 target anomalies.
The range of uncertainty in the costs did not allow selection of any one programme as a clear choice for NHS purchasers. The results suggested that the overall allocation of resources for routine ultrasound screening in the UK is not currently economically efficient, but that certain scenarios for ultrasound screening are potentially within the range of cost effectiveness reached by other, possibly competing, screening programmes. The model highlighted the weakness of available evidence and demonstrated the need for more information both about current practice and costs.
利用现有证据比较不同常规产前超声筛查方案检测四种关键胎儿异常的成本效益，这四种异常为严重心脏异常、脊柱裂、唐氏综合征和致死性异常。
基于当前可得的最佳数据进行决策分析，包括皇家妇产科学院工作小组的专家意见以及文献中的二手数据，以预测每个筛查方案在检测到的畸形方面可能的结果。
结果适用于提供产前筛查的诊所、医院或全科医生诊所。
产前正确检测出的“目标”畸形病例数。
每个筛查方案的成本范围有很大重叠，这表明对于超声筛查替代方案的相对经济效率存在很大不确定性。最便宜但并非最有效的筛查方案包括一次孕中期超声扫描。该方案检测到的每个目标异常的成本（成本效益）在5000英镑至109000英镑之间，但在任何1000名女性中，它也会漏检3.6至4.7个目标异常。
成本的不确定性范围使得国民保健制度购买者无法明确选择任何一个方案。结果表明，英国目前用于常规超声筛查的资源总体分配在经济上并不高效，但某些超声筛查方案在成本效益方面可能处于其他可能相互竞争的筛查方案所达到的范围内。该模型突出了现有证据的不足，并表明需要更多关于当前实践和成本的信息。
