在治疗双胎输血综合征（TTTS）方面，胎腔镜激光与羊膜减张术、隔膜切除术和预期管理的比较：伊朗的经济评估分析。

IF 1.7 4区医学 Q3 HEALTH POLICY & SERVICES Cost Effectiveness and Resource Allocation Pub Date : 2024-05-09 DOI:10.1186/s12962-024-00551-2

Zhila Najafpour, Kamran Shayanfard, Negar Aghighi, Najmieh Saadati

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引用次数: 0

摘要

背景：双胎输血综合征（TTTS10%-15%的单绒毛膜双胎妊娠会患上双胎输血综合征（TTTS）。如果不进行治疗，其死亡率将相当高。不同治疗方法的存活率存在差异。本研究旨在比较在治疗双胎输血综合征（TTTS）时，胎盘镜激光与羊膜减胎术、隔膜切除术和预期管理的成本效益：这是对 TTTS 患者治疗策略的成本效益分析。方法：这是一项针对 TTTS 患者治疗策略的成本效益分析，采用决策树模型来估算妊娠期的临床和经济结果。通过定量研究提取了医疗直接成本，并根据综述确定了存活率作为衡量有效性的指标。采用概率敏感性分析来衡量模型参数不确定性的影响。数据分析使用了 TreeAge、Excel 和 R 软件：第一阶段共纳入 75 项研究。根据荟萃分析，共有 7183 名妇女接受了胎儿镜激光治疗，其中至少有一次双胎妊娠的围产期存活率为 69%。在第二阶段，结果显示预期管理和羊水减量的成本分别最低（791.6 美元）和最高（2020.8 美元）。根据决策模型分析，预期管理的成本最低（791.67 美元），至少一次存活率最高（89%），但仅用于 TTTS 的早期阶段。胎儿镜激光手术的平均成本为 871.46 美元，总存活率为 0.69，被认为是 TTTS 其他阶段最具成本效益的策略：我们的模型发现，在 TTTS 的所有阶段，胎儿镜激光手术都是对 TTTS 患者最具成本效益的治疗方法。因此，胎腔镜激光手术应被视为治疗 TTTS 的合理选择。

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Fetoscopic laser versus amnioreduction, septostomy, and expected management for the treatment of twin-twin transfusion syndrome (TTTS): an economic evaluation analysis in Iran.

Background: Twin-twin transfusion syndrome (TTTS) affects 10-15% of monochorionic twin pregnancies. Without treatment, their mortality rates would be considerable. There are differences in survival rate between different therapeutic modalities. This study aims to compare the cost-effectiveness of Fetoscopic laser versus amnioreduction, septostomy, and expected management in the treatment of twin-to-twin transfusion syndrome (TTTS).

Methods: This is a cost-effectiveness analysis of the treatment strategies in patients with TTTS. A decision tree model was used to estimate the clinical and economic outcomes with a pregnancy period time horizon. Medical direct costs were extracted in a quantitative study, and survival rates were determined as effectiveness measures based on a review. A probabilistic sensitivity analysis was used to measure the effects of uncertainty in the model parameters. The TreeAge, Excel and R software were used for analyzing data.

Results: In the first phase, 75 studies were included in the review. Based on the meta-analysis, a total of 7183 women treated with Fetoscopic laser, the perinatal survival of at least one twin-based pregnancy was 69%. In the second phase, the results showed that expected management and amnioreduction have the lowest (791.6$) and highest cost (2020.8$), respectively. Based on the decision model analysis, expected management had the lowest cost ($791.67) and the highest rate in at least one survival (89%), it was used only in early stages of TTTS. Fetoscopic laser surgery, with the mean cost 871.46$ and an overall survival rate of 0.69 considered the most cost-effectiveness strategy in other stages of TTTS.

Conclusion: Our model found Fetoscopic laser surgery in all stages of TTTS to be the most cost-effective therapy for patients with TTTS. Fetoscopic laser surgery thus should be considered a reasonable treatment option for TTTS.

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来源期刊

Cost Effectiveness and Resource Allocation HEALTH POLICY & SERVICES-

CiteScore

3.40

自引率

4.30%

发文量

审稿时长

34 weeks

期刊介绍： Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.