title: Cost-benefit analysis of prenatal diagnosis for Down syndrome using the British or the American approach.
abstract: OBJECTIVE
  To compare the cost and benefits of prenatal diagnosis for Down syndrome using the British and American approaches.
  
  
  METHODS
  This cost-benefit analysis was based on a decision-analytic approach. The British strategy included screening by a first-trimester ultrasound at 10-14 weeks for nuchal translucency thickness, and the American strategy included only second-trimester screening by using maternal age and maternal serum screening. The key probabilities of the decision-tree analysis and all cost estimates were based on American standards. The best scenario of the British strategy assumed ultrasound nuchal translucency thickness sensitivity (for detecting Down syndrome) of 80% and a false-positive rate of 5% and the worst scenario assumed a sensitivity of 50% and a false-positive rate of 10%. The results were expressed in annual costs based on approximately 4 million births per year in the United States.
  
  
  RESULTS
  As compared with do-nothing, the American strategy was found to allow savings of approximately $96 million per year and the best scenario for the British strategy was savings of approximately $5 million per year. The financial costs of the British and American strategies would be comparable only if the first-trimester ultrasound had a sensitivity of 80% and a false-positive rate of 5% in detecting Down syndrome.
  
  
  CONCLUSIONS
  The British strategy does not appear to be economically beneficial in the United States even under the most ideal scenarios of ultrasound accuracy.
authors.affiliation: Division of Maternal-Fetal Medicine, the Center for Perinatal Health Initiatives, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Vintzileos
authors.forename: C V
authors.initials: CV
authors.lastname: Ananth
authors.forename: J C
authors.initials: JC
authors.lastname: Smulian
authors.forename: D L
authors.initials: DL
authors.lastname: Day-Salvatore
authors.forename: T
authors.initials: T
authors.lastname: Beazoglou
authors.forename: R A
authors.initials: RA
authors.lastname: Knuppel
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*; D012680:Sensitivity and Specificity; D006113:United Kingdom; D014481:United States