title: Cost-effectiveness and accuracy of prenatal Down syndrome screening strategies: should the combined test continue to be widely used?
abstract: OBJECTIVE
  We analyzed the cost-effectiveness (CE) and performances of commonly used prenatal Down syndrome (DS) screening strategies.
  
  
  METHODS
  We performed computer simulations to compare 8 screening options by applying empirical data from Serum, Urine, and Ultrasound Screening Study trials on the population of 110,948 pregnancies. Screening strategies outcomes, CE ratios, and incremental CE ratios were measured.
  
  
  RESULTS
  The most CE DS screening strategy was the contingent screening method (CE ratio of Can$26,833 per DS case). Its incremental CE ratio compared to the second-most CE strategy (serum integrated screening) was Can$3815 per DS birth detected. Among the procedures respecting guidelines, our results identified the combined test as the screening strategy with the highest CE ratio (Can$47,358) and the highest number of procedure-related euploid miscarriages (n = 71).
  
  
  CONCLUSIONS
  In regard to CE, contingent screening is the best choice. The combined test, which is the most popular screening strategy, shows many limitations.
authors.affiliation: Laboratoire de Simulations des Dépistages, Unité de Diagnostic Prénatal, Service de Génétique Médicale, Québec City, Québec, Canada. jean.gekas@mail.chuq.qc.ca
authors.forename: Jean
authors.initials: J
authors.lastname: Gekas
authors.forename: Audrey
authors.initials: A
authors.lastname: Durand
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.forename: Maud
authors.initials: M
authors.lastname: Vallée
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Forest
authors.forename: François
authors.initials: F
authors.lastname: Rousseau
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
mesh_terms: D002170:Canada; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics*; D004314:Down Syndrome / Q000175:diagnosis* / Q000191:economics; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care / Q000191:economics; D011296:Prenatal Diagnosis / Q000191:economics*