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Screening for Down's syndrome: effects, safety, and cost effectiveness of first and second trimester strategies
R E Gilbert1, C Augood, R Gupta
1Systematic Reviews Training Unit, Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH. r.gilbert@ich.ucl.ac.uk
Insights
The integrated test, first trimester combined test, quadruple test, and nuchal translucency measurement are cost-effective antenatal screening strategies for Down
Area of Science:
- Prenatal diagnostics
- Health economics
- Maternal-fetal medicine
Background:
- Antenatal screening for Down's syndrome is crucial for informed decision-making.
- Various screening strategies exist, each with different efficacy, safety profiles, and costs.
- Evaluating these strategies is essential for optimizing healthcare resource allocation.
Purpose of the Study:
- To compare the effectiveness, safety, and cost-effectiveness of different antenatal screening strategies for Down's syndrome.
- To identify optimal screening approaches within the UK healthcare system.
Main Methods:
- Analysis of incremental cost-effectiveness ratios.
- Inclusion of outcomes such as Down's syndrome live births, procedure-related miscarriages, and healthcare costs.
- Focus on strategies including nuchal translucency measurement, integrated test, first trimester combined test, and quadruple test.
Main Results:
- Nuchal translucency measurement was associated with an additional cost of £22,000 per Down's syndrome live birth prevented.
- The integrated test incurred higher costs compared to nuchal translucency measurement.
- Other strategies were found to be less effective or more costly per additional affected birth prevented.
Conclusions:
- The choice of Down's syndrome screening strategy should balance cost-effectiveness, safety, and available budget.
- Recommended strategies include the integrated test, first trimester combined test, quadruple test, and nuchal translucency measurement.
- Screening based solely on maternal age or older biochemical tests is less effective and more costly.
Objective:
To compare the effects, safety, and cost effectiveness of antenatal screening strategies for Down's syndrome.
Design:
Analysis of incremental cost effectiveness.
Setting:
United Kingdom.
Main Outcome Measures:
Number of liveborn babies with Down's syndrome, miscarriages due to chorionic villus sampling or amniocentesis, health care costs of screening programme, and additional costs and additional miscarriages per additional affected live birth prevented by adopting a more effective strategy.
Results:
Compared with no screening, the additional cost per additional liveborn baby with Down's syndrome prevented was 22 000 pound sterling for measurement of nuchal translucency. The cost of the integrated test was 51 000 pound sterling compared with measurement of nuchal translucency. All other strategies were more costly and less effective, or cost more per additional affected baby prevented. Depending on the cost of the screening test, the first trimester combined test and the quadruple test would also be cost effective options.
Conclusions:
The choice of screening strategy should be between the integrated test, first trimester combined test, quadruple test, or nuchal translucency measurement depending on how much service providers are willing to pay, the total budget available, and values on safety. Screening based on maternal age, the second trimester double test, and the first trimester serum test was less effective, less safe, and more costly than these four options.