Cost-effectiveness analysis of prenatal population-based fragile X carrier screening

Thomas J. Musci, Aaron B. Caughey, Wendy Smith, Martin Schwartz, Jone Sampson

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

Objective: To investigate the cost-effectiveness of a widespread prenatal population-based fragile X carrier screening program. Study design: A decision tree was designed comparing screening versus not screening for the fragile X mental retardation protein 1 premutation in all pregnant women. Baseline values included a prevalence of fragile X mental retardation protein 1 premutations of 3.3 per 1000, a premutation expansion rate of 11.3%, and a 99% sensitivity of the screening test. The cost of the screening test was varied from $75 to $300. A sensitivity analysis of the probabilities, utilities, and costs was performed. Results: The screening strategy would lead to the identification of 80% of the fetuses affected by fragile X annually. Assuming the cost of $95 per test and only one child, the program would be cost effective at $14,858 per quality-adjusted life-year. The screening strategy remained cost effective up to $140 per test and 1 child per woman or for 2 children per woman up to a cost of $281 per test. Conclusion: Population-based screening for the fragile X premutation may be both clinically desirable and cost effective. Prospective pilot studies of this screening modality are needed in the prenatal setting.

Original languageEnglish (US)
Pages (from-to)1905-1912
Number of pages8
JournalAmerican journal of obstetrics and gynecology
Volume192
Issue number6
DOIs
StatePublished - Jun 2005

Keywords

  • Cost-effectiveness analysis
  • Fragile X screening
  • Prenatal genetic screening

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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