新生儿危重症先天性心脏病筛查的卫生经济学系统评价

Cost-effectiveness of neonatal major congenital heart disease screening:A systematic review

背景新生儿危重症先天性心脏病(mCHD)筛查技术日臻成熟,然而成熟的技术要具有较好的经济性才可能被广泛接受和应用,目前相关研究不多,且大部分数据来源于发达国家。目的探讨mCHD筛查的有效性和经济性。设计系统评价。方法通过构建P(新生儿)、I[脉搏血氧饱和度(POX)]、R[心脏超声检查(ECHO)、手术]、O(新生儿mCHD)、S(成本分析法、成本效果分析、成本效用分析、成本效益分析)建立检索式,在Medline、Embase、Web of Science、The Cochrane Library、SinoMed、中国知网、万方数据库检索2000年至2022年4月28日的文献。通过阅读题目、摘要和全文筛选,提取文献基本信息,卫生经济学指标(评价方法、研究视角、成本收集范围、敏感性分析类型、贴现率),卫生经济学评价结果[挽救1个生命年(LYS)的成本、获得1个质量调整生命年(QALY)的成本、避免1个伤残调整生命年(DALY)的成本、增加1例及时诊断出病例的成本和增量成本效果/效用比]。文献的质量评价采用卫生经济学评价质量评分量表(QHES)。主要结局指标筛查成本和成本效果。结果纳入2007至2020年11篇文献,能提取单纯POX筛查数据的文献7篇,能提取单纯CE和POX+CE筛查数据的文献各4篇,能提取POX+MUR筛查的文献1篇。社会角度2篇,医疗系统角度9篇;基于人群4篇,基于模型7篇;收集了直接成本和间接成本1篇,收集了直接成本10篇。基于2022年6月汇率折算美元,POX筛查的成本为2~24.5美元,其中人工成本为2.53~7.4美元,一次性探头成本为13.4~22美元,重复性探头成本为0.1~0.9美元。CE筛查的成本为0.5~4.5美元。MUR筛查的成本为1.3~2.0美元。筛查阳性的病例行ECHO费用30~1300美元。8篇文献采用CEA/CUA(成本效果/效用分析)进行筛查的成本效果分析,其中2篇评价POX筛查、5篇POX+CE筛查和1篇POX+MUR,不考虑人工成本的基础上使用一次性探头和ECHO费用是主要筛查成本;POX、POX+MUR和POX+CE具有成本效果,POX+MUR与ECHO相比更具有成本效果,ECHO+CE与POX+CE相比还能检出其他先天性缺陷则具有成本效果。结论mCHD筛查成本主要体现在是否使用一次性探头和超声检查费用;POX、POX+MUR和POX+CE具有成本效果;不同经济发展水平mCHD筛查的经济性可接受。

Background Though screening techniques for neonatal major congenital heart disease(mCHD)are becoming increasingly mature,their widespread acceptance and application still need to be built on economic factors.Currently,there are few studies related to the health economics of mCHD screening,and most of the data are from developed countries.Objective To investigate the effectiveness and economics of mCHD screening.Design Systematic review.Methods The search strategy was established according to the rule of PIROS-participant for neonatal,index for pulse oximetry(POX),reference for echocardiography and surgery,outcome for neonatal mCHD,and study design for cost analysis,cost-effectiveness analysis,cost-utility analysis,and cost-benefit analysis.Web of Science,The Cochrane Library,MedLine,Embase,SinoMed,CNKI,and Wanfang Databases were searched from 2000 to April 28,2022.By reading the title,abstract,and full text,relevant information was extracted including health economics indicators evaluation method,research perspective,cost collection range,sensitivity analysis type,discount rate,and health economics evaluation results such as the cost of saving one Life year(LYS),the cost of gaining a quality adjusted life year(QALY),the cost of avoiding a disability adjusted life year(DALY),the cost of an additional case diagnosed on time,and the incremental cost-effectiveness/utility ratio(ICER).The quality of literature was evaluated by the Quality of Health Economic Studies(QHES)instrument.Main outcome measures The cost and cost-effectiveness of screening.Results Eleven articles were included from 2007 to 2020,of which 7 were able to extract the data of POX screening,4 were able to extract the data of clinical evaluation(CE),and POX+CE screening,and 1 was able to extract the data of POX+MUR screening.There were 2 about social science,9 about medical system,4 about population,7 about models,1 with both direct cost and indirect cost,and 10 with only direct cost.Based on the exchange rate of USD in June 2022,the cost of POX screening is 2-24.5 USD,in which the labor cost is 2.53-7.4 USD,the cost of one-time probe is 13.4-22 USD,and the cost of reusable probe is 0.1-0.9 USD.CE screening costs 0.50-4.50 USD.MUR screening costs 1.30-2.0 USD.Echocardiography(ECHO)costs 30-1300 USD for screening positive cases.CEA/CUA(cost-effectiveness/utility analysis)was used in 8 articles,among which 2 articles evaluated POX screening,5 for POX+CE screening,and 1 for POX+MUR.The cost of using a probe and echocardiography was the main cost of screening without considering labor costs.POX,POX+MUR,and POX+CE have cost effectiveness.POX+MUR has cost effectiveness compared with ECHO.When ECHO+CE can detect other congenital defects,it has cost effectiveness compared with POX+CE.Conclusion The cost of mCHD screening is mainly reflected in whether to use a one-time probe and echocardiography.POX,POX+MUR,and POX+CE have cost effectiveness.Neonatal mCHD screening is economically acceptable at different economic development levels.