title: Preference-sensitive risk-cutoff values for prenatal-integrated screening test for Down syndrome.
abstract: OBJECTIVE
  For a pregnant woman considering prenatal screening for early detection of Down Syndrome (DS), there are at least two major outcomes of interest: undetected DS live births and euploid procedure-related fetal losses. The risk-cutoff value of 1/270 has been commonly used for recommending a diagnostic test. The objective of this study was to assess the impact of women's preferences for different pregnancy outcomes on the optimal risk-cutoff values for integrated screening.
  
  
  METHODS
  We built a Monte Carlo simulation model of 100,000 singleton second-trimester pregnancies to assess the probabilities of DS live births and euploid procedure-related fetal losses for various risk-cutoff values. To capture how undesirable some women may view an undetected DS live birth relative to a euploid procedure-related fetal loss, we used a ratio W1  : W2 of weights (penalties) assigned to these two adverse pregnancy outcomes.
  
  
  RESULTS
  As the relative weight changes, the optimal risk-cutoff value changes significantly.
  
  
  CONCLUSIONS
  A one-size-fits-all risk-cutoff value, such as 1/270, may not always be the best choice, depending on the preferences of women. Preference-sensitive risk-cutoff values for DS screening have the potential to improve the pregnancy outcomes and patient satisfaction.
authors.affiliation: H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Jia
authors.initials: J
authors.lastname: Yan
authors.affiliation: H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Turgay
authors.initials: T
authors.lastname: Ayer
authors.affiliation: H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Pinar
authors.initials: P
authors.lastname: Keskinocak
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000328:Adult; D000465:Algorithms; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D004314:Down Syndrome / Q000175:diagnosis*; D005188:False Negative Reactions; D005260:Female; D005313:Fetal Death; D006801:Humans; D050498:Live Birth; D062145:Maternal Serum Screening Tests / Q000009:adverse effects; D015233:Models, Statistical; D009010:Monte Carlo Method; D057240:Patient Preference; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D050497:Stillbirth