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首页> 外文期刊>Taiwanese journal of obstetrics and gynecology >A cost-effectiveness analysis comparing two different strategies in advanced maternal age: Combined first-trimester screening and maternal blood cell-free DNA testing
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A cost-effectiveness analysis comparing two different strategies in advanced maternal age: Combined first-trimester screening and maternal blood cell-free DNA testing

机译：一种成本效益分析，比较两种不同孕产妇年龄的不同策略：联合三个孕期筛查和孕产妇血液细胞的DNA测试

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ObjectiveTo estimate cost efficacy of first-trimester screening strategies based on nuchal translucency (NT) and maternal blood cell-free DNA (cfDNA) testing in women with advanced maternal age (AMA). Materials and methodsThis was a retrospective population-based analysis of all pregnant women with AMA booked for combined first-trimester screening (cFTS) in China over a 3-year period. The assumed screening strategies were the following: cFTS (Strategy 1), cfDNA testing as a first-tier investigation replacing biomarkers after NT measurement (Strategy 2), and cfDNA testing combined with dating ultrasound for all women (Strategy 3). The direct costs were compared between strategies. ResultsStrategy 1 was completed in 6443 women with AMA. The respective detection rates were 94.5% and 90.9% for trisomies 21 and 18, with a total screen-positive rate of 13.5%. Such a policy resulted in 871 invasive tests and a total cost of $747,870 or a cost of $116 per person tested. Strategy 2 would result in a total cost of $1,812,570, or a cost of $281 per person tested, with increased detection rates for trisomies 21 and 18, and a decreased number of invasive tests compared with strategy 1. The total cost of Strategy 3 would be $1,675,430, or a cost of $260 per person tested with the least number of invasive tests. ConclusionThe cfDNA modalities have the advantages of higher detection rate for common trisomies and lower screening-positive rate. However, the cost of cfDNA testing needs to decrease significantly if it is to replace the current cFTS practice in a population of AMA on a purely cost effectiveness basis.
机译：基于颈部半颌骨半透明（NT）和妇女妇女的孕妇血细胞DNA（CFDNA）在具有先进的孕产妇年龄（AMA）的妇女血液细胞DNA（CFDNA）试验的特调估计成本效力。材料和方法是回顾性的人口，对所有3年期间在中国举行的孕妇筛选（CFTS）合并的AMA的基于孕妇的分析。假设的筛选策略如下：CFTS（策略1），CFDNA测试作为NT测量（策略2）后替代生物标志物的第一层调查，以及CFDNA测试与所有女性的约会超声（策略3）相结合。战略之间比较了直接费用。结果Straingy 1已在6443名妇女与AMA完成。三粒子21和18的各自检测率为94.5％和90.9％，总筛选率为13.5％。这样的政策导致了871次侵入性测试，每人的总成本为747,870美元或每人的费用为116美元。策略2将总成本为1,812,570美元，或者每人测试的费用为2112美元，与三粒子21和18的检测率增加，与策略相比减少了侵入性测试数量。战略3的总成本将是每人1,675,430美元，或每人260美元的费用，具有最少的侵入性测试。结论CFDNA型号具有较高的常见三粒子检出率和较低的筛选阳性率的优点。然而，CFDNA测试的成本如果是在纯粹的成本效益基础上取代AMA群体中的当前CFTS实践，则需要显着降低。

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