title: Economic evaluation of multiplex ligation-dependent probe amplification and karyotyping in prenatal diagnosis: a cost-minimization analysis.
abstract: OBJECTIVE
  To assess the cost-effectiveness of Multiplex Ligation-dependent Probe Amplification (MLPA, P095 kit) compared to karyotyping.
  
  
  METHODS
  A cost-minimization analysis alongside a nationwide prospective clinical study of 4,585 women undergoing amniocentesis on behalf of their age (≥36 years), an increased risk following first trimester prenatal screening or parental anxiety.
  
  
  RESULTS
  Diagnostic accuracy of MLPA (P095 kit) was comparable to karyotyping (1.0 95% CI 0.999-1.0). Health-related quality of life did not differ between the strategies (summary physical health: mean difference 0.31, p = 0.82; summary mental health: mean difference 1.91, p = 0.22). Short-term costs were lower for MLPA: mean difference <euro>315.68 (bootstrap 95% CI <euro>315.63-315.74; -44.4%). The long-term costs were slightly higher for MLPA: mean difference <euro>76.42 (bootstrap 95% CI <euro>71.32-81.52; +8.6%). Total costs were on average <euro>240.13 (bootstrap 95% CI <euro>235.02-245.23; -14.9%) lower in favor of MLPA. Cost differences were sensitive to proportion of terminated pregnancies, sample throughput, individual choice and performance of tests in one laboratory, but not to failure rate or the exclusion of polluted samples.
  
  
  CONCLUSIONS
  From an economic perspective, MLPA is the preferred prenatal diagnostic strategy in women who undergo amniocentesis on behalf of their age, following prenatal screening or parental anxiety.
authors: Department Obstetrics and Gynecology, Academic Medical Centre, Room H4-243, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. e.m.boormans@amc.nl
authors: Elisabeth M A
authors: EM
authors: Boormans
authors: Erwin
authors: E
authors: Birnie
authors: Mariëtte J V
authors: MJ
authors: Hoffer
authors: Merryn V E
authors: MV
authors: Macville
authors: Robert-Jan
authors: RJ
authors: Galjaard
authors: Gijsbertha H
authors: GH
authors: Schuring-Blom
authors: Shama L
authors: SL
authors: Bhola
authors: Karin
authors: K
authors: Huijsdens
authors: Arie
authors: A
authors: Smits
authors: Jan M M
authors: JM
authors: van Lith
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