title: A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome.
abstract: OBJECTIVE
  In maternal serum screening for Down syndrome, a cutoff of 1 : 270 is often used as a decision point to recommend invasive confirmatory testing. However, it has not been established how well this or any other cutoff relates to patient preferences, that is, the values that pregnant women attach to various screening outcomes. The purpose of this study was to examine the clinical and economic tradeoffs of a wide range of risk cutoffs for the quadruple screen.
  
  
  METHODS
  Screening costs and outcomes for multiple risk cutoffs were modeled using a Monte Carlo simulation.
  
  
  RESULTS
  The optimal cutoff for maternal serum screening depends on the relative values placed by the patient on different outcomes. Total societal costs were similar across the range of cutoffs.
  
  
  CONCLUSIONS
  Given that different screening outcomes are optimized by different cutoff values, a one-size-fits-all approach may not be appropriate.
authors.affiliation: ARUP Laboratories, University of Utah, Salt Lake City, UT, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Walker
authors.forename: Edward R
authors.initials: ER
authors.lastname: Ashwood
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jackson
authors.forename: Danielle
authors.initials: D
authors.lastname: Lagrave
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects; D006063:Chorionic Gonadotropin / Q000097:blood; D003365:Costs and Cost Analysis; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis*; D004964:Estriol / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007265:Inhibins / Q000097:blood; D008423:Maternal Age; D009010:Monte Carlo Method; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D000509:alpha-Fetoproteins
chemical_list: D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; C422362:inhibin A; D007265:Inhibins; D004964:Estriol