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Obstetrics & Gynecology 2005;106:562-568
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

A Cost-Effectiveness Analysis of Prenatal Screening Strategies for Down Syndrome

Anthony O. Odibo, MD, MRCOG1,2, David M. Stamilio, MD, MSCE1,2, Deborah B. Nelson, PhD1,2, Harish M. Sehdev, MD3 and George A. Macones, MD, MSCE2

From the 1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Leonard Davis Institute of Health Economics; 2Center for Clinical Epidemiology and Biostatistics University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, Pennsylvania; and 3Pennsylvania Hospital, Obstetrics and Gynecology, Philadelphia, Pennsylvania.

Objective: To evaluate which Down syndrome screening strategy is the most cost-effective.

Methods: Using decision-analysis modeling, we compared the cost-effectiveness of 9 screening strategies for Down syndrome: 1) no screening, 2) first-trimester nuchal translucency (NT) only, 3) first-trimester combined NT and serum screen, 4) first-trimester serum only, 5) quadruple screen, 6) integrated screening, 7) sequential screening, 8) integrated serum only, or 9) maternal age. Costs included cost of tests and resources used for raising a child with Down syndrome. One-way and multiway sensitivity analyses were performed for all model variables. The main outcome measures were cost per Down syndrome case detected, rate of delivering a liveborn neonate with Down syndrome, and rate of diagnostic procedure–related pregnancy loss for each strategy.

Results: Sequential screening detected more Down syndrome cases compared with the other strategies, but it had a higher procedure-related loss rate. Integrated serum screening was the most cost-effective strategy. Sensitivity analyses revealed the model to be robust over a wide range of values for the variables. The addition of the cost of genetic sonogram to the second-trimester strategies resulted in first-trimester combined screening becoming the most cost-effective strategy.

Conclusion: Within our baseline assumptions, integrated serum screening was the most cost-effective screening strategy for Down syndrome. If the cost of nuchal translucency is less than $57 or when genetic sonogram is included in the second-trimester strategies, first-trimester combined screening became the most cost-effective strategy.

Level of Evidence: III






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