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


CONCLUSIONS
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.


METHODS
III.
Odibo
Anthony O
AO
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Philadelphia, Pennsylvania 19104, USA. aodibo@mail.obgyn.upenn.edu
Stamilio
David M
DM
Nelson
Deborah B
DB
Sehdev
Harish M
HM
Macones
George A
GA
D000328:Adult; D000649:Amniocentesis / Q000191:economics; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004314:Down Syndrome / Q000175:diagnosis*; D004964:Estriol / Q000097:blood; D005260:Female; D006801:Humans; D007265:Inhibins / Q000097:blood; D048208:Nuchal Translucency Measurement / Q000191:economics; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics* / Q000379:methods; D013673:Technology Assessment, Biomedical; D014481:United States; D000509:alpha-Fetoproteins / Q000032:analysis
D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins; C094377:inhibin-alpha subunit; D007265:Inhibins; D004964:Estriol