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Obstet Gynecol. 2005 Sep;106(3):562-8.

A cost-effectiveness analysis of prenatal screening strategies for Down syndrome.

Author information

1
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Philadelphia, Pennsylvania 19104, USA. aodibo@mail.obgyn.upenn.edu

Erratum in

  • Obstet Gynecol. 2006 Jan;107(1):209.

Abstract

OBJECTIVE:

To evaluate which Down syndrome screening strategy is the most cost-effective.

METHODS:

Using decision-analysis modeling, we compared the cost-effectiveness of 9 screening strategies for Down syndrome: 1) no screening, 2) first-trimester nuchal translucency (NT) only, 3) first-trimester combined NT and serum screen, 4) first-trimester serum only, 5) quadruple screen, 6) integrated screening, 7) sequential screening, 8) integrated serum only, or 9) maternal age. Costs included cost of tests and resources used for raising a child with Down syndrome. One-way and multiway sensitivity analyses were performed for all model variables. The main outcome measures were cost per Down syndrome case detected, rate of delivering a liveborn neonate with Down syndrome, and rate of diagnostic procedure-related pregnancy loss for each strategy.

RESULTS:

Sequential screening detected more Down syndrome cases compared with the other strategies, but it had a higher procedure-related loss rate. Integrated serum screening was the most cost-effective strategy. Sensitivity analyses revealed the model to be robust over a wide range of values for the variables. The addition of the cost of genetic sonogram to the second-trimester strategies resulted in first-trimester combined screening becoming the most cost-effective strategy.

CONCLUSION:

Within our baseline assumptions, integrated serum screening was the most cost-effective screening strategy for Down syndrome. If the cost of nuchal translucency is less than dollars 57 or when genetic sonogram is included in the second-trimester strategies, first-trimester combined screening became the most cost-effective strategy.

LEVEL OF EVIDENCE:

III.

[Indexed for MEDLINE]

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