高龄孕妇对2种不同唐氏产前诊断方案的需求及经济学评价

The demand and economic evaluation of two strategies for Down syndrome prenatal diagnosis in pregnant women with advanced maternal age

目的:探讨高龄孕妇对2种不同唐氏产前诊断方案的需求,并对这2种方案进行经济学评价。方法:选择2015年3月1日至2016年3月31日孕20+6周前在深圳市妇幼保健院产科就诊的单胎高龄孕妇4104例,由孕妇自主选择先行无创胎儿DNA检测(NIPT),NIPT高风险再行羊膜腔穿刺(方案1)或直接羊膜腔穿刺(方案2)。比较孕妇对2种方案的需求及其影响因素,并对2种方案进行经济学评价。结果:选择方案1的比率明显高于方案2[51.34%(2107/4104)vs 7.65%(314/4104),χ~2=1883.431,P<0.001]。Logistic回归分析显示,孕妇年龄、传统唐氏筛查结果和胎儿颈部透明层厚度(NT)是影响孕妇选择的因素。与方案2相比,方案1可以节省67.21%的总费用。结论:高龄孕妇对NIPT有巨大的需求,且高龄孕妇采用NIPT筛查阳性后再行羊膜腔穿刺术可节省医疗费用,建议在充分知情同意的基础上可将NIPT用于高龄孕妇的一线筛查,尤其是适用于年龄较轻、传统唐氏筛查非高风险、NT正常的高龄孕妇。

Objective： To explore the demand of two options for Down syndrome prenatal diagnosis in pregnant women with advanced maternal age,we did perform economic evaluation of two options.Methods： From March 1 2015 to March 31 2016,a total of 4104 singleton pregnant women of advanced maternal age who required outpatient before 20＋6 weeks of gestation at Shenzhen Maternity and Child Healthcare Hospital were recruited for this study. Women were asked to choose between strategy 1（ NIPT as the initial screening,amniocentesis if positive result from NIPT） and strategy 2（ universal amniocentesis）. The demand and influencing factors of two strategies were compared,and economic evaluation of two strategies were also performed.Results： The percentage of women choosing strategy 1 was higher than that of women choosing strategy 2[51. 34%（ 2107/4104） vs 7. 65%（ 314/4104）,χ2= 1883. 431,P〈0. 001],and Logistic regression analysis showed that maternal age,the result of traditional Down syndrome screening and nuchal translucency（ NT） were influencing factors. Strategy 1 could save67.21% costs compared with strategy 2. Conclusion： There is great demand for NIPT in pregnant women of advanced maternal age.Moreover,amniocentesis for the women with positive result from NIPT can save medical costs.After detail counseling,pregnant women of advanced maternal age can be offered NIPT as the initial screening,especially in women with younger age,non-high risk for traditional Down syndrome screening and normal NT.