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Using decision analysis to compare policies for antenatal screening for Down's syndrome
J Fletcher1, N R Hicks, J D Kay
1Department of Public Health and Health Policy, Oxfordshire Health Authority.
BMJ (Clinical Research Ed.)
|August 5, 1995
Summary
Screening policies for Down's syndrome including maternal serum testing offer improved outcomes but have drawbacks. The best policy depends on individual values and the importance placed on different outcomes.
Area of Science:
- Prenatal diagnostics
- Medical decision analysis
- Public health policy
Background:
- Down's syndrome screening is crucial for prenatal care.
- Maternal serum testing is a key component of modern screening strategies.
- Evaluating different screening policies is essential for optimizing outcomes.
Purpose of the Study:
- To compare various Down's syndrome screening policies.
- To assess the impact of maternal serum testing on outcomes.
- To utilize decision analysis for policy evaluation.
Main Methods:
- Decision tree modeling was employed to predict outcomes.
- Data from local sources and medical literature were integrated.
- Sensitivity analyses were conducted to ensure robustness of findings.
Main Results:
- Screening policies incorporating serum testing yield better population outcomes.
- All considered screening options for Down's syndrome presented significant trade-offs.
- In Oxfordshire, universal serum testing prevented one additional Down's syndrome birth annually compared to age-based screening, at considerable cost.
Conclusions:
- Decision analysis effectively evaluates policy consequences and highlights outcome importance.
- The optimal Down's syndrome screening program choice hinges on the value assigned to various outcomes.
- Divergent individual values may preclude a universally suitable screening policy.