不同孕前优生健康检查策略在甘肃省的实证研究

Spot research on different strategies of preconceptional health examination in Gansu province

目的:探索适合西部地区的孕前优生健康检查策略.方法:在甘肃省按照地域和民族分布特点抽取3个样本点(庄浪县、凉州区、张家川回族自治县),开展3种不同孕前优生健康检查策略的实证比较研究,收集不同策略的风险识别率和检查成本,并对不同策略开展成本效果分析,评价不同策略的适用性.结果:在试点地区,原孕前优生健康检查策略(策略1)风险人群检出率为79%,策略2[孕前和孕期保健指南(2018版)中的必查项目组合]为69.6%,策略3[孕前和孕期保健指南(2018版)中的必查+备查项目组合]为91.7%.策略1检查成本为475.33元/对,策略2为249元/对,策略3为662.67元/对.据此计算成本效果比,策略1、策略2和策略3每检出1例风险人群的成本分别为601.68元、357.76元和722.65元,相对策略2,策略1和策略3的每增加1个单位效果需要额外投入的成本(边际成本)分别是2407.77元/例和1475.12元/例.结论:孕前和孕期指南(2018版)中的必查项目组合更具有经济性.

Objective:To explore a suitable strategy of preconceptional health examination for the western region of China.Methods:Three sample points were selected from Gansu province to conduct a spot study of three different strategies for preconceptional health examination,including Zhuanglang County,Liangzhou District,Zhangjiachuan Hui autonomous County.The risk identification rates and costs of different strategies were collected.The cost-effectiveness ratio(CE)of different strategies was analyzed to evaluate the applicability of strategies.Results:In the pilot areas,the detection rates of high-risk population by the first(as the current pre-pregnancy health examination strategy),the second,and the third strategies of preconceptional health examination were 79%,69.6%,and 91.7%,respectively.The cost of the first,the second,and the third strategies were 475.33Yuan per couple,249Yuan per couple,and 662.67Yuan per couple,respectively.The cost-effectiveness ratios of the three strategies were also calculated.The CEs for the three strategies were 601.68Yuan/case,357.76Yuan/case,and 722.65Yuan/case,respectively.Compared with that of the second strategy,the incremental cost-effectiveness ratio(marginal cost)of the first and the third strategies were 2407.77Yuan/case and 1475.12Yuan/case.Conclusion:The second strategy of preconceptional health examination,including the required items in Chinese guideline of preconception and pregnancy services(2018),has the beat economical efficiency.