背景:双胎输血综合征(TTTS)影响10-15%的单绒毛膜双胎妊娠。如果没有治疗,他们的死亡率将相当可观。不同治疗方式之间的生存率存在差异。本研究旨在比较胎儿镜激光与羊膜减灭术的成本效益,隔膜造口术,以及双胎对双胎输血综合征(TTTS)治疗的预期管理。
方法:这是TTTS患者治疗策略的成本-效果分析。使用决策树模型来估计妊娠期时间范围内的临床和经济结果。在定量研究中提取了医疗直接费用,生存率是根据审查确定的有效性指标。使用概率敏感性分析来衡量模型参数不确定性的影响。TheTreeAge,采用Excel和R软件进行数据分析。
结果:在第一阶段,75项研究纳入审查。根据荟萃分析,共有7183名妇女接受了胎儿镜激光治疗,至少一次双胎妊娠的围产期生存率为69%.在第二阶段,结果表明,预期管理和羊膜减少最低(791.6美元)和最高成本(2020.8美元),分别。基于决策模型分析,预期管理的成本最低(791.67美元),至少一次存活率最高(89%),它仅在TTTS的早期阶段使用。胎儿镜激光手术,在TTTS的其他阶段,平均成本871.46$和总生存率0.69被认为是最具成本效益的策略。
结论:我们的模型发现,在TTTS的所有阶段中,胎儿镜激光手术是TTTS患者最具成本效益的治疗方法。因此,胎儿镜激光手术应被视为TTTS的合理治疗选择。
BACKGROUND: Twin-twin transfusion syndrome (TTTS) affects 10-15% of monochorionic twin pregnancies. Without treatment, their mortality rates would be considerable. There are differences in survival rate between different therapeutic modalities. This study aims to compare the cost-effectiveness of Fetoscopic laser versus amnioreduction, septostomy, and expected management in the treatment of twin-to-twin transfusion syndrome (TTTS).
METHODS: This is a cost-effectiveness analysis of the treatment strategies in patients with TTTS. A decision tree model was used to estimate the clinical and economic outcomes with a pregnancy period time horizon. Medical direct costs were extracted in a quantitative study, and survival rates were determined as effectiveness measures based on a review. A probabilistic sensitivity analysis was used to measure the effects of uncertainty in the model parameters. The TreeAge, Excel and R software were used for analyzing data.
RESULTS: In the first phase, 75 studies were included in the review. Based on the meta-analysis, a total of 7183 women treated with Fetoscopic laser, the perinatal survival of at least one twin-based pregnancy was 69%. In the second phase, the results showed that expected management and amnioreduction have the lowest (791.6$) 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.
CONCLUSIONS: 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.