TY - JOUR
T1 - Nuchal translucency and first trimester biochemical markers for Down syndrome screening
T2 - A cost-effectiveness analysis
AU - Caughey, Aaron B.
AU - Kuppermann, Miriam
AU - Norton, Mary E.
AU - Washington, A. Eugene
N1 - Funding Information:
Supported in part by the National Institute of Child Health and Human Development, grant No. HD01262 (A. B. C., a Women's Reproductive Health Research Scholar) and by the Agency for Healthcare Research and Quality grant No. T32 H500086.
PY - 2002/11/1
Y1 - 2002/11/1
N2 - OBJECTIVE: The purpose of this study was to perform a cost-effectiveness analysis that compared the first-and second-trimester screening tools for Down syndrome. STUDY DESIGN: A decision tree was designed that compared four possible screens for Down syndrome: (1) current second-trimester expanded maternal serum α-fetoprotein test (AFP), (2) first-trimester nuchal translucency screen, (3) first-trimester serum screen, and (4) combined first-trimester screen with both nuchal translucency screen and a serum screen. Incremental cost-benefit and cost-effectiveness ratios were calculated that compared the first-trimester screens with expanded α-fetoprotein. RESULTS: The combined screen (nuchal translucency screen + first-trimester serum screen) identified 3833 Down syndrome fetuses, the nuchal translucency alone identified 3413 Down syndrome fetuses, and the first-trimester serum screen identified 2993 Down syndrome fetuses. Each of these screens was an improvement over the current expanded AFP screen, which diagnosed 2446 Down syndrome fetuses. It would cost $98,381 for each additional Down syndrome case that would be identified by nuchal translucency alone, with a benefit-to-cost ratio of 4.85. The addition of the first-trimester serum screen is still cost-effective compared with expanded AFP; the cost would be $319,934 for each additional Down syndrome fetus who was identified, which would be a benefit-to-cost ratio of 1.57. CONCLUSION: First-trimester screening for Down syndrome with nuchal translucency screening alone or with serum markers is more clinically effective and cost-effective than the current expanded AFP screen that is being used.
AB - OBJECTIVE: The purpose of this study was to perform a cost-effectiveness analysis that compared the first-and second-trimester screening tools for Down syndrome. STUDY DESIGN: A decision tree was designed that compared four possible screens for Down syndrome: (1) current second-trimester expanded maternal serum α-fetoprotein test (AFP), (2) first-trimester nuchal translucency screen, (3) first-trimester serum screen, and (4) combined first-trimester screen with both nuchal translucency screen and a serum screen. Incremental cost-benefit and cost-effectiveness ratios were calculated that compared the first-trimester screens with expanded α-fetoprotein. RESULTS: The combined screen (nuchal translucency screen + first-trimester serum screen) identified 3833 Down syndrome fetuses, the nuchal translucency alone identified 3413 Down syndrome fetuses, and the first-trimester serum screen identified 2993 Down syndrome fetuses. Each of these screens was an improvement over the current expanded AFP screen, which diagnosed 2446 Down syndrome fetuses. It would cost $98,381 for each additional Down syndrome case that would be identified by nuchal translucency alone, with a benefit-to-cost ratio of 4.85. The addition of the first-trimester serum screen is still cost-effective compared with expanded AFP; the cost would be $319,934 for each additional Down syndrome fetus who was identified, which would be a benefit-to-cost ratio of 1.57. CONCLUSION: First-trimester screening for Down syndrome with nuchal translucency screening alone or with serum markers is more clinically effective and cost-effective than the current expanded AFP screen that is being used.
KW - Cost-effectiveness analysis
KW - Down syndrome
KW - Prenatal testing
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U2 - 10.1067/mob.2002.127144
DO - 10.1067/mob.2002.127144
M3 - Article
C2 - 12439512
AN - SCOPUS:0036856194
SN - 0002-9378
VL - 187
SP - 1239
EP - 1245
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 5
ER -