title: Combined first-trimester versus second-trimester serum screening for Down syndrome: a cost analysis.
abstract: OBJECTIVE
  The purpose of this study was to compare the cost-effectiveness of combined first-trimester screening for fetal Down syndrome with second-trimester maternal serum triple screening.
  
  
  METHODS
  A first-trimester screening approach that used nuchal translucency measurement and maternal serum screening was evaluated against second-trimester maternal serum triple screening in a hypothetic population. Screening sensitivities and screen-positive rates were 91% and 5% for the first-trimester approach and 70% and 7.5% for the second-trimester approach, respectively. The costs of fetal Down syndrome, live-born Down syndrome cost, and total costs (screening plus live-born costs) were calculated for each screening program.
  
  
  RESULTS
  First-trimester screening was associated with lower screening and live-born Down syndrome costs versus second-trimester serum screening. Total Down syndrome screening costs were 29.1% lower with first-trimester screening.
  
  
  CONCLUSIONS
  In this hypothetic model, combined first-trimester screening for fetal Down syndrome was more cost-effective than universal second-trimester triple serum screening.
authors.affiliation: Division of Maternal Fetal Medicine, Stamford Hospital, Conn, USA.
authors.forename: William
authors.initials: W
authors.lastname: Cusick
authors.forename: Philip
authors.initials: P
authors.lastname: Buchanan
authors.forename: Terrence W
authors.initials: TW
authors.lastname: Hallahan
authors.forename: David A
authors.initials: DA
authors.lastname: Krantz
authors.forename: John W
authors.initials: JW
authors.lastname: Larsen
authors.forename: James N
authors.initials: JN
authors.lastname: Macri
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004314:Down Syndrome / Q000175:diagnosis* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009333:Neck / Q000196:embryology; D011247:Pregnancy / Q000097:blood; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D016216:Ultrasonography, Prenatal