唐氏综合征产前筛查方案选择的成本-效果分析

A Cost-effectiveness Analysis of Prenatal Screening for Down's Syndrome

目的：从经济学的角度探讨适合中国国情的唐氏综合征产前筛查方案。方法：运用成本效果分析，计算两联筛查和三联筛查不同检出率与假阳性率下每检出1例唐氏综合征的费用，并进行比较，费用最低方案为优选方案。结果：在以医院为中心筛查情况下，在37．39％的产前诊断率时，酶联免疫法两联筛查每检出1例唐氏综合征费用在336156-845274元；时间分辨法两联筛查每检出1例唐氏综合征费用在600727-1756865元；化学发光法三联筛查每检出1例唐氏综合征费用在743756元-2404572元。结论：酶联免疫法两联筛查最佳方案为方案E（检出率84．62％，假阳性率9．32％），每检出1例唐氏综合征费用最低（336156元）；时间分辨法两联筛查最佳方案为方案H（检出率77．78％，假阳性率21．46％），每检出1例唐氏综合征费用最低（600727元）；化学发光法三联筛查最佳方案为方案H（检出率90．91％，假阳性率6．14％），每检出1例唐氏综合征费用最低（743756元）。

Objective： To find out the most economical schemes of prenatal screening for Down＇s syndrome. Methods： Dectection rates by the methods of double and triple screening were analysed on the basis of cost - effectiveness analysis, and the cost of per Down＇s syndrome founded out was calculated and compared. Results： The costs per Down＇s syndrome detected by methods of double - test enzyme linkedimmunsorbsent assay （ ELISA）, double - test time resolved fluoroisnmunoassay （ TRFIA ） and triple - test chemiluminesent immunoassay were336,156 - 845,274 RMB, 600,727 - 1,756,865 RMB and 743,756 - 2, 404,572 RMB, respectively. Conclusion： The best schemes of double- test ELISA, double- test TRFIA and triple -test Chemiluminesent Immunoassay were project E, H and H, and the lowest cost of per Down＇s syndrome detected was 336,156 RMB, 600,727 RMB and 743,756 RMB, respectively, with 84.62%, 77.78%, 90. 91% for detection rate and 9.32%, 21.46% and 6. 14% for false positive rate.