title: Time and travel costs incurred by women attending antenatal tests: A costing study.
abstract: OBJECTIVE
  to estimate the costs to women, their friends and family for different antenatal tests in the Down's syndrome (DS) screening pathway.
  
  
  METHODS
  questionnaire-based costing study.
  
  
  METHODS
  eight maternity clinics across the UK.
  
  
  METHODS
  pregnant women (n=574) attending an appointment for DS screening, NIPT or invasive testing between December 2013 and September 2014.
  
  
  METHODS
  using data collected from the questionnaires we calculated the total costs to women by multiplying the time spent at the hospital and travelling to and from it by the opportunity costs of the women and accompanying person and adding travel and childcare costs. Assumptions about the value of opportunity costs were tested in one-way sensitivity analyses. The main outcome measure was the mean cost to the women and friends/family for each test (DS screening, NIPT, and invasive testing).
  
  
  RESULTS
  mean costs to women and their family/friend were £33.96 per visit, of which £22.47 were time costs, £9.15 were travel costs and £2.34 were childcare costs. Costs were lowest for NIPT (£22), £32 for DS screening (£44 if combined with NIPT), and highest for invasive testing (£60). Sensitivity analysis revealed that variations around the value of leisure time opportunity costs had the largest influence on the results.
  
  
  CONCLUSIONS
  there are considerable costs to women, their friends and family when attending different tests in the DS screening pathway.
  
  
  CONCLUSIONS
  when assessing the cost-effectiveness of changes to this pathway, costs to women should be considered.
authors.affiliation: Department of Applied Health Research, University College London, London, UK. Electronic address: t.verhoef@ucl.ac.uk.
authors.forename: Talitha I
authors.initials: TI
authors.lastname: Verhoef
authors.affiliation: North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Daley
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Vallejo-Torres
authors.affiliation: North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Genetics and Genomic Medicine, Institute of Child Health, London, UK.
authors.forename: Lyn S
authors.initials: LS
authors.lastname: Chitty
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
mesh_terms: D003362:Cost-Benefit Analysis / Q000592:standards*; D004314:Down Syndrome / Q000175:diagnosis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D011795:Surveys and Questionnaires; D014195:Travel / Q000191:economics*
keywords: Cell free DNA; Down's syndrome screening; Health economics; Non-invasive prenatal testing; Patient costs