title: Prenatal screening costs at a large military treatment facility.
abstract: OBJECTIVE
  Prenatal screening with cell-free DNA (cfDNA) offers improved detection of Down syndrome (T21) compared to conventional screening. These tests are expensive and have fewer detectable anomalies. Our objective was to investigate potential costs and test performance of screening algorithms when accounting for detectable aneuploidies.
  
  
  METHODS
  This is a cost analysis for a large military treatment facility. Using a theoretical delivery cohort and published performance data, universal screening with cfDNA was compared to sequential screening, comparing T21 to all detectable aneuploidies. Predicted test performance and costs were calculated.
  
  
  RESULTS
  A cohort of 3000 deliveries was used. For T21, universal cfDNA is more expensive ($1,346,064) than sequential screening ($244,885), but has a lower false positive rate and avoids 101 invasive diagnostic tests. An additional case of T21 is detected with a marginal cost of $1,101,179. For all detectable aneuploidies, cfDNA is more expensive ($1,353,660) than sequential screening ($239,189), and 59 invasive diagnostic tests are avoided. Sequential screening detects an additional case of aneuploidy, with a cost savings of $1,114,471.
  
  
  CONCLUSIONS
  Although cfDNA is superior in detecting T21 cases, sequential screening is superior when considering all aneuploidies detectable. The cost increase with universal cfDNA is significant, and is not justified with small improvements in the performance.
authors.affiliation: a Department of Obstetrics and Gynecology , Naval Medical Center San Diego , San Diego , CA , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Shiv
authors.affiliation: a Department of Obstetrics and Gynecology , Naval Medical Center San Diego , San Diego , CA , USA.
authors.forename: Taylor J
authors.initials: TJ
authors.lastname: Sale
authors.affiliation: a Department of Obstetrics and Gynecology , Naval Medical Center San Diego , San Diego , CA , USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Simsiman
authors.affiliation: a Department of Obstetrics and Gynecology , Naval Medical Center San Diego , San Diego , CA , USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Leininger
authors.affiliation: a Department of Obstetrics and Gynecology , Naval Medical Center San Diego , San Diego , CA , USA.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Lutgendorf
mesh_terms: D000649:Amniocentesis / Q000706:statistics & numerical data; D000782:Aneuploidy; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004247:DNA / Q000097:blood*; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics* / Q000379:methods; D012680:Sensitivity and Specificity
chemical_list: D004247:DNA
keywords: Cell-free DNA; cost analysis; noninvasive prenatal testing; sequential screening