title: [Effects, safety and cost-benefit analysis of Down syndrome screening in first trimester].
abstract: OBJECTIVE
  To investigate the effects, safety and cost-benefit analysis of Down syndrome screening in first trimester.
  
  
  METHODS
  From January 2009 to December 2012, 43 729 pregnant women undergoing 3 methods of Down syndrome traditional screening strategies in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively, including in 17 502 cases in pregnancy associated plasma protein A (PAPP-A) and free β-hCG measured biochemistry screening, 14 080 cases in nuchal translucency (NT) screening and 12 147 cases in combined screening, meanwhile, 7 389 cases on non-invasive fetal trisomy test (NIFTY) were performed in Huada Gene Research Institute(BGI). The effects and safety of four screening strategies were assessed throughout a decision tree. The economical characters of each screening strategy were compared by cost-effectiveness analysis as well as cost-benefit analysis.
  
  
  RESULTS
  (1) The effects of four strategies are: NIFTY > combined screening > NT screening > biochemistry screening. (2) The safety of four strategies are: NIFTY > combined screening > NT screening > biochemistry screening. (3) Cost-effectiveness analysis and cost-benefit analysis:the biochemistry screening has lowest cost-effectiveness ratio (CER) and highest cost-benefit ratio (CBR), which performed a better economical efficiency. The incremental CER of three traditional screening strategies are all less than the economical burden of Down syndrome.NIFTY has highest CER and negative net present value (NPV), NPV would be positive and CBR would be more than 1 if the price of NIFTY reduce to 1 434 Yuan.
  
  
  CONCLUSIONS
  Combined screening possess best screening efficiency, while biochemistry screening was demonstrated more economical in traditional screening.NIFTY is the future of Down syndrome screening.
authors.affiliation: Department of Obstetrics and Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen 518028, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Shengmou
authors.affiliation: Institute of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Min
authors.affiliation: Email: szwangchenhong@vip.163.com.
authors.forename: Wang
authors.initials: W
authors.lastname: Chenhong
authors.forename: Li
authors.initials: L
authors.lastname: Shengli
authors.forename: Xie
authors.initials: X
authors.lastname: Jiansheng
authors.forename: Yuan
authors.initials: Y
authors.lastname: Hui
authors.forename: Lin
authors.initials: L
authors.lastname: Dinghao
authors.forename: Wu
authors.initials: W
authors.lastname: Xiaoxia
authors.forename: Wang
authors.initials: W
authors.lastname: Wei
authors.forename: Zhang
authors.initials: Z
authors.lastname: Hongyun
authors.forename: Tang
authors.initials: T
authors.lastname: Haiyan
mesh_terms: D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000009:adverse effects / Q000097:blood*; D003362:Cost-Benefit Analysis; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D048208:Nuchal Translucency Measurement / Q000009:adverse effects / Q000191:economics; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000009:adverse effects / Q000032:analysis*; D011296:Prenatal Diagnosis / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A