姙娠糖尿病篩檢策略之成本效果分析

目標：姙娠糖尿病（gestational diabetes mellitus，GDM）與孕婦及新生兒發生第二型糖尿病與不良結果有關。篩檢是辨識孕婦是否罹患姙娠糖尿病的重要方法，全面篩檢與高風險族群篩檢係重要的篩檢策略，但目前對於合適的篩檢策略尚缺乏共識。因此，本研究目的為從第三付費者觀點，探討姙娠糖尿病篩檢策略之成本效果。方法：本研究以決策樹模型評估三種姙娠糖尿病篩檢策略之成本以及健康生活品質校正生命年（quality-adjusted life years，QALYs）：全面篩檢、高風險族群篩檢、未篩檢。本研究使用全民健康保險研究資料庫資料與文獻回顧估計模型參數，及敏感度分析評估研究結果的穩健度。結果：相較於未篩檢，全面篩檢與高風險族群篩檢皆具備成本效果，與高風險族群篩檢及未篩檢相比，全面篩檢能減少姙娠糖尿病併發症發生風險，全面篩檢相較高風險族群篩檢的遞增成本效果比，每增加一個健康生活品質校正生命年需增加928元成本，敏感度分析結果一致。結論：全面篩檢係有成本效果之姙娠糖尿病篩檢策略，並能改善孕婦及新生兒照護結果。

關鍵字

姙娠糖尿病；全面篩檢；高風險族群篩檢；成本效果；遞增成本效果比

並列摘要

Objectives: Gestational diabetes mellitus (GDM) is associated with type 2 diabetes mellitus and adverse outcomes for both mothers and infants. Screening is a valuable method for identifying women at risk for GDM, and universal screening along with targeted screening is a key strategy for such identification. However, consensus is lacking regarding which GDM screening strategy is appropriate for pregnant women. Hence, the objective of this study was to compare the cost-effectiveness of GDM screening strategies from the third payer perspective. Methods: A decision tree model was used to assess the costs and quality-adjusted life years (QALYs) for three GDM screening strategies: universal screening, targeted screening, and no screening. The Taiwan National Health Insurance Research Database and a literature review were used to estimate the model parameters. Sensitivity analysis was performed to evaluate the robustness of assessment. Results: Compared with the no screening strategy, universal screening and targeted screening were cost-effective. Universal screening was a cost-effective approach for decreasing the risks of GDM complications compared with targeted screening or no screening. Relative to targeted screening, universal screening generated an incremental cost-effectiveness ratio of $928/QALY gained. Sensitivity analysis provided similar results. Conclusions: Universal screening is a cost-effective approach for improving maternal and neonatal outcomes.

並列關鍵字

gestational diabetes mellitus ； universal screening ； targeted screening ； cost-effective ； incremental cost-effectiveness ratio

參考文獻

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姙娠糖尿病篩檢策略之成本效果分析

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