全球精选文摘 - 产前筛查新生儿自身免疫性血小板减少的费用效益比较

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产前筛查新生儿自身免疫性血小板减少的费用效益比较

Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia

Killie MK, Kjeldsen-Kragh J, Husebekk A 2009/5/27 10:50:39

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BJOG, 2007,

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Abstract
Objectives:
To estimate the costs and health consequences of three different screening strategies for neonatal alloimmune thrombocytopenia (NAIT).

Design:
Cost–utility analysis on the basis of a decision tree that incorporates the relevant strategies and outcomes.

Setting:
Three health regions in Norway encompassing a 2.78 million population.

Population:
Pregnant women (n=100,448) screened for human platelet antigen (HPA) 1a and anti-HPA 1a antibodies, and their babies.

Method:
Decision tree analysis. In three branches of the decision tree, pregnant women entered a programme while in one no screening was performed. The three different screening strategies included all HPA 1a negative women, only HPA 1a negative, HLA DRB3*0101 positive women or only HPA 1a negative women with high level of anti-HPA 1a antibodies. Included women underwent ultrasound examination and elective caesarean section 2–4 weeks before term. Severely thrombocytopenic newborns were transfused immediately with compatible platelets.

Main Outcome Measurements:
Quality-adjusted life years (QALYs) and costs.

Results:
Compared with no screening, a programme of screening and subsequent treatment would generate between 210 and 230 additional QALYs among 100 000 pregnant women, and at the same time, reduce health care costs by approximately €1.7 million. The sensitivity analyses indicate that screening is cost effective or even cost saving within a wide range of probabilities and costs.

Conclusion:
Our calculations indicate that it is possible to establish an antenatal screening programme for NAIT that is cost effective.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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