文章摘要
韩优莉,黄丽辉,张巍,张燕梅,贾晓,倪婷婷,孙慧红,梁萍,于环,郭燕,张爱,李嘉慧,张华.北京市三阶段新生儿听力筛查成本效果分析[J].中华流行病学杂志,2015,36(5):455-459
北京市三阶段新生儿听力筛查成本效果分析
Cost-effectiveness of three-stage newborns hearing screening in Beijing
投稿时间:2014-10-30  
DOI:10.3760/cma.j.issn.0254-6450.2015.05.010
中文关键词: 听力筛查;成本效果分析;新生儿
英文关键词: Hearing screening;Cost-effectiveness;Newborn
基金项目:首都医学发展科研基金(2009-1049)
作者单位E-mail
韩优莉 100069 北京, 首都医科大学卫生管理与教育学院  
黄丽辉 北京同仁医院北京市耳鼻咽喉科研究所  
张巍 北京妇产医院新生儿科 zw296@sina.com 
张燕梅 北京同仁医院北京市耳鼻咽喉科研究所  
贾晓 北京妇产医院新生儿科  
倪婷婷 北京同仁医院北京市耳鼻咽喉科研究所  
孙慧红 北京妇产医院新生儿科  
梁萍 北京市大兴区妇幼保健院  
于环 北京丰台医院  
郭燕 北京市中西医结合医院  
张爱 北京市丰台区妇幼保健院  
李嘉慧 北京市顺义区中医医院  
张华 北京市顺义区妇幼保健院  
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中文摘要:
      目的 比较新生儿听力筛查两阶段和三阶段的成本效果, 为普遍性筛查提供依据。方法 对2010年10月至2012年12月北京市7家医院出生的正常新生儿进行听力筛查, 分别采用两阶段和三阶段策略及听力诊断性检查, 比较两种筛查的成本/效果比。其中筛查和诊断成本数据源自医院, 采用自行设计问卷对家长调查额外交通费和误工费。根据依从率进行敏感性分析。结果 新生儿初筛62 695人, 未通过5 809人, 阳性率为9.30%;复筛4 933人, 未通过972人, 阳性率为19.70%;复筛未通过并就诊于指定医疗机构者412人。完成诊断性评估360人, 听力异常者217例, 听力异常率为60.28%。完成三阶段筛查共276人, 未通过163人。其中125人完成诊断性检查, 异常112例(中度以上45例), 听力异常率为89.60%。以实际筛查率和诊断率计算成本/效果比, 两阶段(19 985元/例)优于三阶段(37 242元/例), 但随着筛查依从率的提高, 三阶段筛查的成本效果也随之提高。结论 筛查依从率影响三阶段筛查的成本效果, 在筛查依从率较高(>90%)的地区可考虑使用三阶段筛查方法。
英文摘要:
      Objective To evaluate the cost-effectiveness of two-stage and three-stage hearing screenings for newborns. Methods Hearing screening was performed for the normal newborns born in 7 hospitals in Beijing from October 2010 to December 2012 by using two stage and three stage strategies as well as hearing diagnostic test, and the cost effectiveness evaluation of two strategies was conducted. The data about the cost of screening and diagnostic test were from the hospitals. The data about car fare and charge for loss of working time of parents were collected through questionnaire survey. The sensitivity was analyzed according to the compliance rate. Results A total of 62 695 newborns received initial hearing screening, 5 809 newborns failed, the positive rate was 9.30%. A total of 4 933 newborns received rescreening, 972 newborns failed, the positive rate was 19.70%. Among the newborns failed in rescreening, 412 were provided with hearing diagnostic test and 360 received diagnostic test. The diagnostic test indicated that the hearing of 217 newborns were abnormal (60.28%). A total of 276 newborns received the third screening, 163 newborns failed, in which 125 received diagnostic test and 112 had abnormal hearing (45 had moderate and above hearing impairment), the abnormal rate was 89.60%. The average cost for three-stage screening (37 242 yuan RMB per case) was higher than that for two-stage screening (19 985 yuan RMB per case). With the increase of compliance, the cost-effectiveness of three-stage screening increased. Conclusion The cost-effectiveness of three-stage screening was influenced by screening compliance. It is recommended that three-stage screening strategy might be taken in area where the screening compliance rate is >90%.
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