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

作　　者：陆天玮 胡晓静[2,3] 张崇凡 黄国英[2,3,4,5] LU Tianwei;HU Xiaojing;ZHANG Chongfan;HUANG Guoying(Fudan University School of Public Health,Shanghai 200032,China;a National Management Office of Neonatal Screening Project for CHD,Children's Hospital of Fudan University,Shanghai 201102,China;Pediatric Heart Center,Children's Hospital of Fudan University,Shanghai 201102,China;Fudan University GRADE Center,Children's Hospital of Fudan University,Shanghai 201102,China;Shanghai Key Laboratory of Birth Defects,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]复旦大学附属儿科医院新生儿先心病筛查国家级项目管理办公室,上海201102 [3]复旦大学附属儿科医院心血管中心,上海201102 [4]复旦大学附属儿科医院复旦大学GRADE中心,上海201102 [5]复旦大学附属儿科医院上海市出生缺陷重点实验室,上海201102

出　　处：《中国循证儿科杂志》2022年第3期195-201,I0001-I0003,共10页Chinese Journal of Evidence Based Pediatrics

基　　金：国家重点研发计划项目:2021YFC2701000,2016YFC1000500。

摘　　要：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 scree

关 键 词：危重症先天性心脏病 新生儿筛查 卫生经济学评价 成本-效果分析 系统评价 

分 类 号：R722.1[医药卫生—儿科] R1[医药卫生—临床医学]