RESUMO
OBJECTIVE: Determine cost differences between cell-free DNA (cfDNA) and serum integrated screening (INT) in obese women given the limitations of aneuploidy screening in this population. METHODS: Using a decision-analytic model, we estimated the cost-effectiveness of trisomy 21 screening in class III obese women using cfDNA compared with INT. Primary outcomes of the model were cost, number of unnecessary invasive tests, procedure-related fetal losses, and missed cases of trisomy 21. RESULTS: In base case, the mean cost of cfDNA was $498 greater than INT ($1399 vs $901). cfDNA resulted in lower probabilities of unnecessary invasive testing (2.9% vs 3.5%), procedure-related loss (0.015% vs 0.019%), and missed cases of T21 (0.00013% vs 0.02%). cfDNA cost $87 485 per unnecessary invasive test avoided, $11 million per procedure-related fetal loss avoided, and $2.2 million per missed case of T21 avoided. In sensitivity analysis, when the probability of insufficient fetal fraction is assumed to be >25%, cfDNA is both costlier than INT and results in more unnecessary invasive testing (a dominated strategy). CONCLUSION: When the probability of insufficient fetal fraction more than 25% (a maternal weight of ≥300 lbs), cfDNA is costlier and results in more unnecessary invasive testing than INT.
Assuntos
Análise Custo-Benefício , Síndrome de Down/diagnóstico , Teste Pré-Natal não Invasivo/métodos , Obesidade Materna/sangue , Aborto Induzido/economia , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/economia , Aborto Espontâneo/epidemiologia , Amniocentese/economia , Amostra da Vilosidade Coriônica/economia , Técnicas de Apoio para a Decisão , Síndrome de Down/economia , Feminino , Humanos , Testes para Triagem do Soro Materno/economia , Testes para Triagem do Soro Materno/métodos , Diagnóstico Ausente/economia , Diagnóstico Ausente/estatística & dados numéricos , Teste Pré-Natal não Invasivo/economia , Gravidez , Natimorto/economia , Natimorto/epidemiologiaRESUMO
AIM: To examine the burden of out-of-pocket household expenditures and time spent on care by families responsible for children with Down Syndrome (DS). METHODS: A cross-sectional analysis was performed after surveying families of children with DS. The children all received medical care at the Hospital Infantil de México Federico Gomez (HIMFG), a National Institute of Health. Data were collected on out-of-pocket household expenditures for the medical care of these children. The percentage of such expenditure was calculated in relation to available household expenditure (after subtracting the cost of food/housing), and the percentage of households with catastrophic expenditure. Finally, the time spent on the care of the child was assessed. RESULTS: The socioeconomic analysis showed that 67% of the households with children with DS who received medical care in the HIMFG were within the lower four deciles (I-IV) of expenses, indicating a limited ability to pay for medical services. Yearly out-of-pocket expenditures for a child with DS represented 27% of the available household expenditure, which is equivalent to $464 for the United States dollars (USD). On average, 33% of families with DS children had catastrophic expenses, and 46% of the families had to borrow money to pay for medical expenses. The percentage of catastrophic expenditure was greater for a household with children aged five or older compared with households with younger children. The regression analysis revealed that the age of the child is the most significant factor determining the time spent on care. CONCLUSIONS: Some Mexican families of children with DS incur substantial out-of-pocket expenditures, which constitute an economic burden for families of children who received medical care at the HIMFG.
Assuntos
Síndrome de Down/economia , Gastos em Saúde , Hospitais , Assistência ao Paciente/economia , Doença Catastrófica/economia , Criança , Pré-Escolar , Características da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Análise de Regressão , Fatores de TempoRESUMO
OBJECTIVE: To assess the direct annual health care costs for children and adolescents with Down syndrome in Western Australia and to explore the variation in health care use including respite, according to age and disease profile. STUDY DESIGN: Population-based data were derived from a cross-sectional questionnaire that was distributed to all families who had a child with Down syndrome as old as 25 years of age in Western Australia. RESULTS: Seventy-three percent of families (363/500) responded to the survey. Mean annual cost was $4209 Australian dollars ($4287 US dollars) for direct health care including hospital, medical, pharmaceutical, respite and therapy, with a median cost of $1701. Overall, costs decreased with age. The decline in costs was a result of decreasing use of hospital, medical, and therapy costs with age. Conversely, respite increased with age and also with dependency. Health care costs were greater in all age groups with increasing dependency and for an earlier or current diagnosis of congenital heart disease. Annual health care costs did not vary with parental income, including cost of respite. CONCLUSIONS: Direct health care costs for children with Down syndrome decrease with age to approximate population costs, although costs of respite show an increasing trend.
Assuntos
Síndrome de Down/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Fatores Etários , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Avaliação da Deficiência , Pessoas com Deficiência , Síndrome de Down/epidemiologia , Feminino , Cardiopatias Congênitas/economia , Cardiopatias Congênitas/epidemiologia , Humanos , Hidroterapia/economia , Lactente , Recém-Nascido , Masculino , Terapia Ocupacional/economia , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Modalidades de Fisioterapia/economia , Cuidados Intermitentes/economia , Fonoterapia/economia , Inquéritos e Questionários , Natação/economia , Adulto JovemRESUMO
OBJECTIVE: To measure the co-morbidities associated with Down syndrome compared with those in other children with special health care needs (CSHCN). Additionally, to examine reported access to care, family impact, and unmet needs for children with Down syndrome compared with other CSHCN. STUDY DESIGN: An analysis was conducted on the nationally representative 2005 to 2006 National Survey of Children with Special Health Care Needs. Bivariate analyses compared children with Down syndrome with all other CSHCN. Multivariate analyses examined the role of demographic, socioeconomic, and medical factors on measures of care receipt and family impact. RESULTS: An estimated 98,000 CSHCN have Down syndrome nationally. Compared with other CSHCN, children with Down syndrome had a greater number of co-morbid conditions, were more likely to have unmet needs, faced greater family impacts, and were less likely to have access to a medical home. These differences become more pronounced for children without insurance and from low socioeconomic status families. CONCLUSIONS: Children with Down syndrome disproportionately face greater disease burden, more negatively pronounced family impacts, and greater unmet needs than other CSHCN. Promoting medical homes at the practice level and use of those services by children with Down syndrome and other CSHCN may help mitigate these family impacts.
Assuntos
Efeitos Psicossociais da Doença , Crianças com Deficiência , Síndrome de Down/economia , Síndrome de Down/epidemiologia , Família , Acessibilidade aos Serviços de Saúde , Criança , Comorbidade , Emprego , Feminino , Gastos em Saúde , Necessidades e Demandas de Serviços de Saúde , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Assistência Centrada no Paciente , Classe Social , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To use health care insurance claims data from a privately insured population to estimate health care use and expenditures for infants and children aged 0 to 4 years with Down syndrome. STUDY DESIGN: Data from the 2004 Medstat MarketScan database were used to estimate medical care use and expenditures related to inpatient admissions, outpatient services, and prescription drug claims for children with and those without Down syndrome. Costs were further stratified by the presence or absence of a congenital heart defect (CHD). RESULTS: The mean medical costs for infants and children with Down syndrome were $36384 during 2004; median medical costs were $11164. Mean and median medical costs for children 0 to 4 years of age with Down syndrome were 12 to 13 times higher than for children without Down syndrome. For infants with Down syndrome and CHDs, mean and median costs were 5 to 7 times higher than for infants with Down syndrome who did not have CHDs. CONCLUSIONS: These findings may facilitate future assessments of the effect of the Down syndrome on the health care system.