Cost-effectiveness analysis of prenatal diagnosis intervention for Down's syndrome in China.
OBJECTIVE
The cost-effectiveness of prenatal diagnosis intervention for Down's syndrome (DS) in China was assessed and evidence-based information for policy makers and providers is presented.


METHODS
Based on field surveys in four selected cities in China and a literature review, the economic evaluation of prenatal diagnosis for DS from a societal perspective is conducted by cost-effectiveness analysis.


RESULTS
In current clinical practice, for a cohort of 10,000 pregnant women, the strategy that delivers karyotyping by chorionic villus sampling (CVS) or amniocentesis (AC) only to those pregnant women 35 years of age and older (maternal age screening strategy) can detect .67 DS births. The strategy that offers the diagnostic test after maternal serum screening with alpha-fetoprotein and human chorionic gonadotrophin (maternal serum screening strategy) can detect 1.41 DS births. The cost per prevented DS birth by the maternal age screening strategy and maternal serum screening strategy is US$ 13,091 and US$ 56,048, respectively. Sensitivity analysis shows that the maternal serum screening strategy can be cost-effective if uptake rate of CVS or AC for patients with positive serum tests increase while the cost of serum screening decreases.


CONCLUSIONS
Although, in general, serum screening has been found to be more cost-effective than maternal age screening, this appears not to be the case in China. The reasons appear to be low uptake rate of the maternal serum strategy, low uptake rate of CVS or AC, and the high price of serum screening. Our findings are that health system factors concerning technology utilization are important determinants of the technology's efficiency.
Chen
Yingyao
Y
National Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, P.R. China. yychen@shmu.edu.cn
Qian
Xu
X
Li
Jun
J
Zhang
Jie
J
Chu
Annie
A
Schweitzer
Stuart O
SO
D000328:Adult; D002681:China; D003362:Cost-Benefit Analysis; D003625:Data Collection; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*