title: Economic analysis of chromosome testing in couples with recurrent miscarriage to prevent handicapped offspring.
abstract: OBJECTIVE
  Which strategy is least expensive to prevent the birth of a handicapped child in couples with recurrent miscarriage (RM); parental chromosome analysis followed by amniocentesis in case of carrier status of one of the parents, or amniocentesis in all ongoing pregnancies without the knowledge of parental carrier status?
  
  
  CONCLUSIONS
  For virtually all couples with RM amniocentesis in all ongoing pregnancies without the knowledge of parental carrier status is less expensive in preventing the birth of a handicapped child than parental chromosome analysis followed by amniocentesis in case of carrier status of one of the parents.
  
  
  BACKGROUND
  One of the causes of RM is a balanced chromosome abnormality in one of the partners. If one of the partners is carrier of a balanced structural chromosomal abnormality, the risk of offspring with an unbalanced structural chromosome abnormality is increased. Like all couples, couples with RM also have an age-dependent risk for fetal aneuploidy, of which trisomy 21 is most common.
  
  
  METHODS
  Model-based economic analysis to compare costs and effects of two strategies in couples with RM to prevent the birth of a handicapped child in case of ongoing pregnancy.
  
  
  METHODS
  Comparison of two strategies in women with RM: strategy (I) parental chromosome analysis followed by amniocentesis in pregnancy in case of carrier status of one of the parents and strategy (II) amniocentesis in all ongoing pregnancies without the knowledge of carrier status. No testing was the reference strategy. Data on probabilities and costs were derived from the literature. Incremental costs and effects were calculated [incremental cost-effectiveness ratio (ICER)]. Effectiveness was expressed as the number of prevented births of handicapped child equivalents compared with no testing. In these calculations, the birth of a handicapped child was valued 10 times worse than the loss of a viable pregnancy due to amniocentesis.
  
  
  RESULTS
  Depending on the risk for carrier status, the ICER for Strategy I (parental chromosome analysis followed by amniocentesis in case of carrier status of one of the parents) varied between € 226,000 and € 6,556,000 per prevented handicapped child equivalent. For Strategy II (amniocentesis in all ongoing pregnancies without the knowledge of carrier status), the ICER varied between € 2000 and € 233 000 per prevented handicapped child equivalent. Strategy I was less expensive than Strategy II only for a small subgroup of couples with maternal age <23 years, three or more previous miscarriages and a family history of RM.
  
  
  CONCLUSIONS
  Our analysis is not a plea for amniocentesis in all women with RM. Individual risk assessment with serum markers and nuchal translucency is probably more effective at lower cost.
  
  
  CONCLUSIONS
  This analysis can be used by clinicians to explain the chances of adverse pregnancy outcome in couples with RM, as well as by policy makers in health-care economics. Future guidelines on RM might be more restrictive from the perspective of the limited health-care resources that we have available.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22700, Amsterdam 1105 DE, The Netherlands. marsha.vanleeuwen@amc.uva.nl
authors.forename: M
authors.initials: M
authors.lastname: van Leeuwen
authors.forename: F
authors.initials: F
authors.lastname: Vansenne
authors.forename: J C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: M
authors.initials: M
authors.lastname: Goddijn
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000026:Abortion, Habitual / Q000235:genetics*; D000367:Age Factors; D000649:Amniocentesis / Q000191:economics*; D000782:Aneuploidy; D025063:Chromosome Disorders / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D005260:Female; D005817:Genetic Counseling; D005820:Genetic Testing / Q000191:economics*; D006579:Heterozygote; D006801:Humans; D008297:Male; D008423:Maternal Age; D011247:Pregnancy
keywords: amniocentesis; economic analysis; parental karyotyping; recurrent miscarriage