■评估在32岁和32岁时开始产前胎儿监测的相对成本效益36周,在药物治疗的妊娠期糖尿病中。
■我们对接受BPPs的药物治疗的GDM患者进行了2017-2022年的回顾性队列研究。24周前确诊的患者,那些在32周之前交付的,和那些没有BPP或交付数据的被排除。人口统计学和结果数据通过图表审查进行抽象。我们对两个结果进行了成本效益分析:死产,并决定在异常BPP后改变交货时间。
■共纳入652例妊娠。49%的病人是私人保险,25%的公共保险,26%没有保险。我们假设每个BPP的成本为145美元。总的来说,36周后发生了1,284次BPP,成本为186,180美元,2,041BPP发生在32至36周之间,额外花费295,945美元。异常BPP导致12次交付,36周后。没有发生死胎。所有患者避免一次死产的费用为40,177美元。在我们的样本中,在36周开始监测理论上可以避免所有死胎,私人保险患者每次避免死产的成本节省为51,572美元,公共保险患者14,123美元,和17,799美元的病人没有保险。
■基于该人群,没有死胎,也没有规定在36周之前分娩的BPPs,36周后的监测可能是安全且具有成本效益的.我们的发现反映了共同决策和潜在实践变化的机会,对社会经济地位低的患者和没有保险的患者影响最大。
UNASSIGNED: To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes.
UNASSIGNED: We performed a 2017-2022 retrospective cohort study of patients with medication-treated GDM who underwent BPPs. Patients diagnosed before 24 weeks, those delivered before 32 weeks, and those without BPPs or delivery data were excluded. Demographic and outcome data were abstracted by chart review. We performed a cost-effectiveness analysis regarding two outcomes: stillbirth, and decision to alter delivery timing following abnormal BPPs.
UNASSIGNED: A total of 652 pregnancies were included. Patients were 49% privately insured, 25% publicly insured, and 26% uninsured. We assumed that each BPP cost $145. In total, 1,284 BPPs occurred after 36 weeks, costing $186,180, and 2,041 BPPs occurred between 32 and 36 weeks, costing an additional $295,945. Twelve deliveries resulted from abnormal BPPs, all after 36 weeks. No stillbirths occurred. The cost to attempt to avoid one stillbirth was $40,177 across all patients. In our sample, starting surveillance at 36 weeks would have theoretically avoided all stillbirths, with cost savings per avoided stillbirth of $51,572 for privately insured patients, $14,123 for publicly insured patients, and $17,799 for patients without insurance.
UNASSIGNED: Based on this population with no stillbirths and no BPPs dictating delivery before 36 weeks, surveillance after 36 weeks may be safe and cost-effective. Our findings reflect opportunities for shared decision making and potential practice change, with greatest impact for low socioeconomic status patients and those without insurance.