PDF(Pubmed)
Abstract：
BACKGROUND: Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members\' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs.
OBJECTIVE: The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs.
METHODS: A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted.
RESULTS: Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers\' HRQoL, and the impact of neonatal demise on mothers\' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers\' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children.
CONCLUSIONS: Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
OBJECTIVE: The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs.
METHODS: A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted.
RESULTS: Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers\' HRQoL, and the impact of neonatal demise on mothers\' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers\' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children.
CONCLUSIONS: Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
摘要：
背景：在怀孕或分娩期间实施的围产期干预措施具有影响母亲健康相关生活质量（HRQoL）的独特特征，胎儿,和新生儿。然而,孕产妇-围产期成本-效用分析(CUA)通常只考虑孕产妇或儿童健康结局.挑战包括,但不限于,测量胎儿，新生,和婴儿健康结果，并评估其对产妇HRQoL的影响。同样重要的是要认识到孕产妇-围产期健康对家庭成员HRQoL的影响(即，家庭溢出效应)，并将这些效应纳入孕产妇-围产期CUA。
目的：目的是系统地回顾用于包括孕妇健康结局的方法，胎儿,和儿童，并将家庭溢出效应纳入孕产妇-围产期CUA。
方法：在Medline进行了文献检索，Embase,EconLit,科克伦收藏,护理和相关健康文献累积指数(CINAHL)，国际卫生技术评估机构网络(INAHTA)，和儿科经济数据库评估（PEDE）数据库从开始到2020年，以确定孕产妇围产期CUA，其中包括孕妇的健康结果，胎儿,和/或孩子。搜索已使用PEDE更新至2022年12月。描述母亲健康结果的数据，胎儿,孩子们被测量，合并,并报告了家庭溢出效应的数据。
结果：在确定的174个孕产妇围产期CUA中，62考虑了孕妇的健康结果，还有孩子.在54个基于质量调整生命年(QALY)的CUA中，12包括胎儿健康结局，胎儿丢失对母亲HRQoL的影响，以及新生儿死亡对母亲HRQoL的影响。四项研究考虑了胎儿健康结局和胎儿丢失对母亲HRQoL的影响。一项研究包括胎儿健康结局以及新生儿死亡对产妇HRQoL的影响。此外，六项研究考虑了新生儿死亡对产妇HRQoL的影响，其中4例包括胎儿健康结局。一项研究包括胎儿丢失对产妇HRQoL的影响。其余26项仅包括孕妇和儿童的健康结果。在八个基于残疾调整生命年(DALY)的CUA中，两个测量胎儿健康结果。在174项研究中，只有一项研究包括家庭溢出效应。最常见的测量方法是分别测量孕妇和儿童的健康结果。使用各种方法来评估QALYs或DALYs的胎儿损失及其对母亲HRQoL的影响。最常见的整合方法是对孕妇和儿童的QYs或DYs求和。大多数研究报告了结合的QALY和增量QALY，或DALYs和增量DALYs，在家庭层面为孕妇和儿童。
结论：大约三分之一的孕产妇-围产期CUA包括孕妇的健康结局，胎儿,和/或孩子。孕产妇围产期干预的未来CUA，从社会的角度来看，应该旨在纳入母亲的健康结果，胎儿,和孩子在适当的时候。这些CUA中使用的各种方法突出了对标准化测量和集成方法的需求，可能导致严格和标准化的包容实践，提供更高质量的证据，以更好地告知决策者有关孕产妇-围产期干预措施的成本和收益。卫生技术评估机构可能会考虑在未来的更新中为影响未来生活的干预措施提供指导。
目的：目的是系统地回顾用于包括孕妇健康结局的方法，胎儿,和儿童，并将家庭溢出效应纳入孕产妇-围产期CUA。
方法：在Medline进行了文献检索，Embase,EconLit,科克伦收藏,护理和相关健康文献累积指数(CINAHL)，国际卫生技术评估机构网络(INAHTA)，和儿科经济数据库评估（PEDE）数据库从开始到2020年，以确定孕产妇围产期CUA，其中包括孕妇的健康结果，胎儿,和/或孩子。搜索已使用PEDE更新至2022年12月。描述母亲健康结果的数据，胎儿,孩子们被测量，合并,并报告了家庭溢出效应的数据。
结果：在确定的174个孕产妇围产期CUA中，62考虑了孕妇的健康结果，还有孩子.在54个基于质量调整生命年(QALY)的CUA中，12包括胎儿健康结局，胎儿丢失对母亲HRQoL的影响，以及新生儿死亡对母亲HRQoL的影响。四项研究考虑了胎儿健康结局和胎儿丢失对母亲HRQoL的影响。一项研究包括胎儿健康结局以及新生儿死亡对产妇HRQoL的影响。此外，六项研究考虑了新生儿死亡对产妇HRQoL的影响，其中4例包括胎儿健康结局。一项研究包括胎儿丢失对产妇HRQoL的影响。其余26项仅包括孕妇和儿童的健康结果。在八个基于残疾调整生命年(DALY)的CUA中，两个测量胎儿健康结果。在174项研究中，只有一项研究包括家庭溢出效应。最常见的测量方法是分别测量孕妇和儿童的健康结果。使用各种方法来评估QALYs或DALYs的胎儿损失及其对母亲HRQoL的影响。最常见的整合方法是对孕妇和儿童的QYs或DYs求和。大多数研究报告了结合的QALY和增量QALY，或DALYs和增量DALYs，在家庭层面为孕妇和儿童。
结论：大约三分之一的孕产妇-围产期CUA包括孕妇的健康结局，胎儿,和/或孩子。孕产妇围产期干预的未来CUA，从社会的角度来看，应该旨在纳入母亲的健康结果，胎儿,和孩子在适当的时候。这些CUA中使用的各种方法突出了对标准化测量和集成方法的需求，可能导致严格和标准化的包容实践，提供更高质量的证据，以更好地告知决策者有关孕产妇-围产期干预措施的成本和收益。卫生技术评估机构可能会考虑在未来的更新中为影响未来生活的干预措施提供指导。
