Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model 英文参考文献.docVIP

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Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model 英文参考文献.doc

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Maternal Serologic Screening to Prevent Congenital Toxoplasmosis A Decision-Analytic Economic Model 英文参考文献

MaternalSerologicScreeningtoPreventCongenital Toxoplasmosis:ADecision-AnalyticEconomicModel EileenStillwaggon1*,ChristopherS.Carrier1,MariSautter2,RimaMcLeod2 1DepartmentofEconomics,GettysburgCollege,Gettysburg,Pennsylvania,UnitedStatesofAmerica,2DivisionofOphthalmologyandVisualSciences,Departmentof Surgery,TheUniversityofChicago,Chicago,Illinois,UnitedStatesofAmerica Abstract Objective:Todetermineacost-minimizingoptionforcongenitaltoxoplasmosisintheUnitedStates. Methodology/PrincipalFindings:Adecision-analyticandcost-minimizationmodelwasconstructedtocomparemonthly maternalserologicalscreening,prenataltreatment,andpost-natalfollow-upandtreatmentaccordingtothecurrentFrench (Paris)protocol,versusnosystematicscreeningorperinataltreatment.Costsarebasedonpublishedestimatesoflifetime societalcostsofdevelopmentaldisabilitiesandcurrentdiagnosticandtreatmentcosts.Probabilitiesarebasedonpublished results and clinical practice in the United States and France. One- and two-way sensitivity analyses are used toevaluate robustness of results. Universal monthly maternal screening for congenital toxoplasmosis with follow-up and treatment, followingtheFrenchprotocol,is foundtobecost-saving, withsavingsof $620perchildscreened. Resultsarerobustto changesintestcosts,valueofstatisticallife,seroprevalenceinwomenofchildbearingage,fetallossduetoamniocentesis, andtobivariateanalysisoftestcostsandincidenceofprimaryT.gondiiinfectioninpregnancy.Giventheparametersinthis model and a maternal screening test cost of $12, screening is cost-saving for rates of congenital infection above 1 per 10,000livebirths.Ifuniversaltestinggenerateseconomiesofscaleindiagnostictools—loweringtestcoststoabout$ 2per test—universalscreeningiscost-savingatratesofcongenitalinfectionwellbelowthelowestreportedratesintheUnited Statesof1per10,000livebirths. Conclusion/Significance:UniversalscreeningaccordingtotheFrenchprotocoliscostsavingfortheUSpopulationwithin broadparametersforcostsandprobabilities. Citation:Still