System dynamics in early health technology assessment (eHTA): Prenatal screening technology (ELI-P Complex).

摘要

Rapid growth of technological innovations in the medical field makes health technology assessment (HTA) an essential process in the operation of modern healthcare systems. HTA, inherently multidisciplinary and complex, is evolving in many, directions and seeking for greater efficiency and effectiveness through the adoption of new methodologies and practices. This dissertation uses system dynamics (SD) as an assessment tool for prenatal screening technology and policy analysis.; The evaluated ELI-P Complex test is a biochemical system for pre-pregnancy/pre-natal screening used to determine the probability of pathology in pregnancy through the evaluation of the immunoregulatory state of fertile females. Simulation is designed to run at a relatively high level of aggregation for the time period between 2010 and 2035. It allows tracing of the model's dynamics at the population (US) level of technology application in order to conduct an integrated policy analysis for prenatal care under various implementation scenarios of the ELI-P Complex.; US prenatal care at the beginning of the 21st century is costly and rather cultural than effective: the consequences of unsuccessful pregnancies, birth defects and children with congenital defects that become apparent later in life, have very high economic and social costs.; Initial investment into the introduction and dissemination of the technology and screening costs per year are estimated to be significantly lower than the savings that result from the number of birth defects and pathological pregnancy outcomes prevented. Simulation results clearly point to the benefits of the ELI-P Complex screening which, if applied at the population level, helps monitor female reproductive health and achieve noticeable improvements in the overall health status of new generations. The estimate for the cost of intervention is less than US{dollar}25,000 per case avoided, which makes the screening program cost-effective.; This dissertation is accompanied by a CD with the ELI-P Complex Simulator developed in STELLARTM: user-friendly interface allows people with no prior knowledge of software to investigate various scenarios of the ELI-P Complex screening program introduction.