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目的:探讨高龄孕妇对2种不同唐氏产前诊断方案的需求,并对这2种方案进行经济学评价。方法:选择2015年3月1日至2016年3月31日孕20+6周前在深圳市妇幼保健院产科就诊的单胎高龄孕妇4104例,由孕妇自主选择先行无创胎儿DNA检测(NIPT),NIPT高风险再行羊膜腔穿刺(方案1)或直接羊膜腔穿刺(方案2)。比较孕妇对2种方案的需求及其影响因素,并对2种方案进行经济学评价。结果:选择方案1的比率明显高于方案2[51.34%(2107/4104)vs 7.65%(314/4104),χ~2=1883.431,P<0.001]。Logistic回归分析显示,孕妇年龄、传统唐氏筛查结果和胎儿颈部透明层厚度(NT)是影响孕妇选择的因素。与方案2相比,方案1可以节省67.21%的总费用。结论:高龄孕妇对NIPT有巨大的需求,且高龄孕妇采用NIPT筛查阳性后再行羊膜腔穿刺术可节省医疗费用,建议在充分知情同意的基础上可将NIPT用于高龄孕妇的一线筛查,尤其是适用于年龄较轻、传统唐氏筛查非高风险、NT正常的高龄孕妇。
OBJECTIVE: To investigate the needs of pregnant women with advanced prenatal diagnosis of two different Down’s prenatal diagnosis programs and to evaluate the economics of the two programs. Methods: A total of 4104 singleton pregnant women were enrolled in this study from March 1, 2015 to March 31, 2016 at 20 + 6 weeks before pregnancy. The pregnant women chose the noninvasive fetal DNA test (NIPT) , NIPT with high-risk amniocentesis (protocol 1) or direct amniocentesis (protocol 2). Comparison of pregnant women on the two programs of demand and its influencing factors, and two kinds of programs for economic evaluation. Results: The rate of option 1 was significantly higher than that of option 2 [51.34% (2107/4104) vs 7.65% (314/4104), χ ~ 2 = 1883.431, P <0.001]. Logistic regression analysis showed that the age of pregnant women, the traditional Down’s screening results and the thickness of the fetal neck transparent layer (NT) are the factors affecting the choice of pregnant women. Compared with Option 2, Option 1 can save 67.21% of the total cost. Conclusion: Elderly pregnant women have a huge demand for NIPT, and elderly pregnant women with NIPT screening positive after the amniocentesis can save medical costs, it is recommended based on the full informed consent of NIPT can be used for first-line screening of pregnant women , Especially for younger, traditional Down’s non-high-risk, normal NT pregnant women.