一种新型胎儿膀胱-羊膜分流术-漩涡分流术的成本-效果分析。

IF 2.7 2区 医学 Q2 GENETICS & HEREDITY
Prenatal Diagnosis Pub Date : 2025-02-01 Epub Date: 2024-12-20 DOI:10.1002/pd.6729
Jamie A Schlacter, Enrico Danzer, Claire H Packer, Eric Johnson, Aaron B Caughey, Yair J Blumenfeld, Kunj R Sheth
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引用次数: 0

摘要

目的:我们评估涡旋分流器的潜在结果、成本和成本效益,涡旋分流器是一种新型胎儿膀胱羊膜分流器(VAS),与标准分流器相比,用于治疗胎儿下尿路梗阻(LUTO)。方法:我们设计了一个决策分析模型,比较涡旋分流和电流分流,使用相当于每年美国LUTO病例的1000例妊娠的理论队列。目前的文献表明,目前的分流器有50%的脱位风险和36%的终末期肾病(ESRD)概率,而漩涡分流器的临床前研究预计有10%的脱位风险和18%的ESRD率。结果包括早产、胎膜早破(PPROM)、ESRD、神经发育迟缓(NDD)、新生儿死亡、成本和质量调整生命年(QALYs)。我们从文献中导出模型输入并进行敏感性分析。结果:在1000例LUTO妊娠中,Vortex分流术减少了70例ESRD, 110例早产,50例PPROM发作,10例NDD患儿。涡旋分流术是具有较高QALYs的主要策略,估计每个接受VAS的胎儿终身节省168,520美元。Vortex分流在98%的情况下具有成本效益。结论:我们的理论模型表明涡旋分流器比电流分流器更具成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-Effectiveness Analysis of a Novel Fetal Vesicoamniotic Shunt-The Vortex Shunt.

Objective: We estimated the potential outcomes, costs, and cost-effectiveness of the Vortex shunt, a novel fetal vesicoamniotic shunt (VAS), compared to standard shunts for treating fetal lower urinary tract obstruction (LUTO).

Method: We designed a decision-analytic model comparing the Vortex shunt to current shunts using a theoretical cohort of 1000 pregnancies equivalent to the annual U.S. LUTO cases. Current literature indicates a 50% dislodgement risk and a 36% end-stage renal disease (ESRD) probability for current shunts versus the Vortex shunt's expected 10% dislodgement risk and 18% ESRD rate from pre-clinical studies. Outcomes included preterm delivery, preterm premature rupture of membrane (PPROM), ESRD, neurodevelopmental delay (NDD), neonatal death, costs, and quality-adjusted life years (QALYs). We derived model inputs from the literature and conducted sensitivity analyses.

Results: Of 1000 theoretical LUTO pregnancies, the Vortex shunt resulted in 70 fewer cases of ESRD, 110 fewer preterm deliveries, 50 fewer episodes of PPROM, and 10 fewer children with NDD. The Vortex shunt was the dominant strategy with higher QALYs and estimated lifetime savings of $168,520 for each fetus undergoing VAS. The Vortex shunt was cost-effective 98% of the time.

Conclusion: Our theoretical model suggests that the Vortex shunt is cost-effective compared to current shunts.

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来源期刊
Prenatal Diagnosis
Prenatal Diagnosis 医学-妇产科学
CiteScore
5.80
自引率
13.30%
发文量
204
审稿时长
2 months
期刊介绍: Prenatal Diagnosis welcomes submissions in all aspects of prenatal diagnosis with a particular focus on areas in which molecular biology and genetics interface with prenatal care and therapy, encompassing: all aspects of fetal imaging, including sonography and magnetic resonance imaging; prenatal cytogenetics, including molecular studies and array CGH; prenatal screening studies; fetal cells and cell-free nucleic acids in maternal blood and other fluids; preimplantation genetic diagnosis (PGD); prenatal diagnosis of single gene disorders, including metabolic disorders; fetal therapy; fetal and placental development and pathology; development and evaluation of laboratory services for prenatal diagnosis; psychosocial, legal, ethical and economic aspects of prenatal diagnosis; prenatal genetic counseling
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