Appraisal of a new scheme for prenatal screening for Down's syndrome.
OBJECTIVE
To appraise a new method of prenatal screening for Down's syndrome based on maternal serum concentrations of alpha fetoprotein, unconjugated oestriol, and human chorionic gonadotrophin combined with maternal age--the "triple test."


METHODS
Examination of the cost effectiveness of the triple test relative to screening only by maternal age over a range of population detection rates.


METHODS
Leicestershire Health Authority.


METHODS
Costs per affected fetus detected.


RESULTS
The triple test is more cost effective than screening only by maternal age for risk cut off points for amniocentesis, resulting in a detection rate over 45%. The most efficient detection rate is around 60-65%, for which the cost per case detected is around 29,000 pounds, through screening with higher detection rates is still likely to be cost beneficial.


CONCLUSIONS
Prenatal screening for Down's syndrome based on the triple test should replace screening based only on maternal age. Individual women's preferences should be elicited by the use of structured decision analysis in order to maximise utility and so increase the benefits of the screening programme.
Sheldon
T A
TA
Department of Public Health Medicine, University of Leeds.
Simpson
J
J
D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D004314:Down Syndrome / Q000175:diagnosis*; D004964:Estriol / Q000097:blood; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D008423:Maternal Age; D011237:Predictive Value of Tests; D011247:Pregnancy / Q000097:blood*; D037841:Pregnant People; D011296:Prenatal Diagnosis / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D004964:Estriol