ความคุ้มทุนโครงการควบคุมและป้องกันโรคเลือดจางธาลัสซีเมียในหญิงตั้งครรภ์ที่โรงพยาบาลศูนย์สุรินทร์

Abstract

Abstract:

Objective: To study the cost - effectiveness of prevention and control for thalassemia in pregnant
 women project at Surin Hospital. Patients and Methods: Pregnant women with gestational age
less  than 16 weeks who visited the antenatal care unit from October 2002 to March 2005. They were
screened  by OF (Osmotic Fragility Test) or MCV (Mean Corpusular Volumn) and DCIP (Dichlophenol
- Indophenol Precipitation Test). Among those women with abnormal tests ,their husbans were identified
 and screened.If they also had abnormal tests both of them were taken blood samples for confirmed
tests (Hemoglobin typing, %Hb A2, PCR (Polymerase Chain Reaction) at Department of Paediatrics,
Faculty of Medicine, Chiangmai University. The couples at risk of severe thalassemia (Homozygous
β  - thalassemia, β - thalassemia / Hemoglobin E and Hemoglobin Bart’s Hydrops fetalis)  were advised
 to perform prenatal diagnosis (Cordocentesis). Termination of pregnancy  was done when the
result  of fetal blood were severe thalassemia. The total cost of the project was evaluated and compared
with  an estimated cost of the affected babies who would have survived without the project. Results:
5,554  pregnant women were screened, with 3,111 (56%) having an abnormal result. Among those with
abnormal  tests, 2,530 (81.3%) husbans were screened. 1,525 husbans (60.2%) had abnormal test result.
Prenatal  diagnosis of thalassemia was performed in 48 pregnant women. Eight fetuses had severe
thalassemia  and 6 of these pregnancies were terminated. The total cost of the project was 694,490 baht
compared  with an estimated cost of 891,000 baht for 5 cases that would have survived without the
project (77.9%). Summary: This project is cost - effective but should have the saved and suitable
screening  methods for this area.