| Objective:In order to carry out the health economics evaluation of the implementation of free programs and explore the economic benefits brought by the increase of coverage of free programs,it is vital to understand the relevant policies of free prenatal screening and diagnosis project in Fujian Province and clarify policy changes in recent years.Meanwhile,measuring the economic burden of Down syndrome in Fujian Province is necessary as well.On the basis of the analysis above,this paper puts forward some policy suggestions for the comprehensive implementation of free projects by relevant departments.Methods:This paper summarizes the related policies of free projects in Fujian Province and other provinces in literature review.After this,the economic burden of Down syndrome in Fujian Province will be calculated by the expenditure data of Fujian New Rural Cooperative Medical Insurance,monitoring and current data of Maternity and Child Care Center in Fujian Province from 2012 to 2016.Finally,the Decision Tree model is constructed to evaluate the health economics of free projects in Fujian Province.Then,a one-way sensitivity analysis were performed to assess other influencing factors.Results:There are two main changes in free prenatal program policy in Fujian Province.One is the larger coverage of the program in all counties.The other one is the beneficiaries are expanded from rural and urban low-income pregnant women to the whole pregnant women who participate in the medical insurance of urban and rural residents in Fujian Province.(2)The free projects Fujian Province was generally well from 2010 to 2018.The total number of people receiving serological screening was about 810,000.15,490 cases accepted interventional prenatal diagnosis.Among these,211 cases were diagnosed as Down syndrome.The implementation rate of serological screening was almost 100% from 2016 to 2018.And avoid birth rate of children with Down syndrome was above 90% since 2015.(3)The average cost of each new Down syndrome case is 2.21 million,of which the direct economic burden is 6.56 hundred thousand,accounting for 3.9% of the total burden.The indirect economic burden is 2.12 million,accounting for 96.1% of the total burden.The largest loss of labor was 1.46 million,accounting for 66.2% of the total disease economic burden.(4)The cost-effectiveness analysis showed that from the perspective of health system,compared with 2010,the incremental effect ratio of free projects in 2018 was 166,000 yuan per case;From a social perspective,the incremental effect ratio is 269,000 yuan per case,which is less than three times of GDP per capita of Fujian Province.It can be seen that free projects have a good cost efficiency.The cost-benefit analysis showed that the coverage rate of free projects increased from 2.19% in 2010 to 34.43% in 2018.The net benefit was 18,411.5 yuan and cost-benefit ratio were 8.2.From the perspective of health system,the net benefit of free projects is negative and the cost-benefit ratio is less than 1.Therefore,the evaluation effect is not ideal.The single-factor sensitivity analysis showed that the rate of prenatal diagnosis,the coverage rate of free programs and avoid birth rate of children with Down syndrome were the important factors affecting the BCR of free programs.Conclusions:(1)The economic cost for Down syndrome is high so that the prevention of birth defect is quite important.(2)The project has good health economic value.Relevant tests still meets the cost-effectiveness principle even if the occurrence of Down syndrome remains low.Compared with the initial stage of the project,the coverage of the free screening project in 2018 in Fujian Province has enlarged,which avoids more new-born babies with Down’s disease and increases the social and economic benefits.More specifically,1 yuan of investment could return the benefit of8.2 yuan. |
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