title: Cost-effectiveness analysis of triple test in second-trimester maternal serum screening for Down's syndrome: an experience from Taiwan with decreasing birth rate but increasing population of old pregnant women.
abstract: OBJECTIVE
  We intended to assess the cost-effectiveness of adding unconjugated oestriol (uE3) in maternal serum screening for Down's syndrome in Taiwan, where there is a decreasing birth rate but an increasing trend of old women having pregnancies.
  
  
  METHODS
  We used logistic regressions to estimate the risk of Down's syndrome with maternal age and different combinations of biomarkers. Cost-effectiveness analysis was presented in terms of the average and incremental cost-effectiveness ratios. Sensitivity analyses with different parameters were performed.
  
  
  RESULTS
  Given a cut-off point of 1:270 for the confirmation of Down's syndrome with amniocentesis, the average cost per case averted for maternal age above 35 years only, double test [alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG)] and triple test (AFP, hCG and uE3) were estimated as $14,561, $42,367 and $37,424. The additional costs per case averted for double test and triple test (compared with maternal age above 35 years) were $135,950 and $77,394, respectively. The additional cost per case averted for triple test was $15 199 compared with double test.
  
  
  CONCLUSIONS
  The performance of triple test is not only more effective in detecting Down's syndrome cases but also more cost-effective than double test in this study.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsiao-Lin
authors.initials: HL
authors.lastname: Hwa
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Yen
authors.forename: Chen-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Tsang-Ming
authors.initials: TM
authors.lastname: Ko
authors.forename: Fon-Jou
authors.initials: FJ
authors.lastname: Hsieh
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000328:Adult; D001723:Birth Rate / Q000639:trends*; D003362:Cost-Benefit Analysis / Q000379:methods; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D015233:Models, Statistical; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood*; D044967:Serum; D013624:Taiwan / Q000453:epidemiology