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Combined first-trimester versus second-trimester serum screening for Down syndrome: a cost analysis
William Cusick1, Philip Buchanan, Terrence W Hallahan
1Division of Maternal Fetal Medicine, Stamford Hospital, Conn, USA.
American Journal of Obstetrics and Gynecology
|March 14, 2003
Summary
Combined first-trimester screening for fetal Down syndrome is more cost-effective than second-trimester screening. This approach offers lower screening and live-born Down syndrome costs, reducing overall expenses by 29.1%.
Area of Science:
- Prenatal diagnostics
- Maternal-fetal medicine
- Health economics
Background:
- Second-trimester maternal serum triple screening has been a standard for fetal Down syndrome detection.
- Evaluating newer screening methods is crucial for optimizing prenatal care and resource allocation.
Purpose of the Study:
- To compare the cost-effectiveness of combined first-trimester screening versus second-trimester triple serum screening for fetal Down syndrome.
- To analyze screening performance metrics including sensitivity and screen-positive rates.
Main Methods:
- A hypothetical population model was used to compare two screening strategies.
- Evaluated first-trimester screening (nuchal translucency + maternal serum) against second-trimester screening.
- Calculated costs associated with screening, live-born Down syndrome, and total program expenses.
Main Results:
- First-trimester screening demonstrated higher sensitivity (91%) and a lower screen-positive rate (5%) compared to second-trimester screening (70% sensitivity, 7.5% positive rate).
- First-trimester screening resulted in lower overall costs, with total Down syndrome screening costs being 29.1% lower.
- Associated costs for both screening and live-born Down syndrome were reduced with the first-trimester approach.
Conclusions:
- Combined first-trimester screening for fetal Down syndrome is a more cost-effective strategy than universal second-trimester triple serum screening in this hypothetical model.
- The findings suggest a shift towards earlier, more effective screening methods can improve both clinical outcomes and economic efficiency in prenatal diagnostics.