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The cost effectiveness of prenatal ultrasound screening for trisomy 21

Published online by Cambridge University Press:  01 November 2004

Anthony H. Harris
Anthony H. Harris
Affiliation:
Monash University
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Abstract

Objectives: The cost-effectiveness of opportunistic nuchal translucency ultrasound screening in pregnancy was compared with alternative screening strategies for trisomy 21 in Australia.

Methods: A decision analytic model was used of various pregnancy screening strategies based on a systematic review of the literature on the effectiveness of nuchal translucency ultrasound and serum screening and costs based on current reimbursement fees. The model included the likelihood and cost of terminations after diagnostic testing and the associated risk of fetal loss. All prices are in 2001 Australian dollars.

Results: With a twenty percentage point difference in detection rate, the incremental cost for a combination of nuchal translucency and serum screening with age in the first trimester compared with maternal serum screening in the second trimester was $105,484 per extra case detected and $374,779 per live trisomy 21 birth avoided. Serum screening in the second trimester had an incremental cost per extra case detected of between $61,700 and $117,100 per extra live birth avoided when compared with no screening.

Conclusions: The cost-effectiveness of ultrasound screening for trisomy 21 would appear to be more attractive if it were done at the same time as current dating ultrasound. Any funding mechanism for screening should take this strategy into account by incorporating, as far as possible, provision of nuchal translucency screening into existing services provided in early pregnancy.

Keywords

UltrasoundPrenatal screeningCost-effectiveness
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 464 - 468
Copyright
© 2004 Cambridge University Press

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References

Cheffins T, Chan A, Haan EA, et al. 2000 The impact of maternal serum screening on the birth prevalence of Down's syndrome and the use of amniocentesis and chorionic villus sampling in South Australia. Br J Obstet Gynaecol. 107: 1453– 1459.Google Scholar
Cuckle HS, Wald NJ. 1990 Screening for Downs syndrome. In: Lilford R, ed. Prenatal diagnosis and prognosis. London: Butterworths; 67– 89.
Gilbert RE, Augood C, Gupta R, et al. 2001 Screening for Down's syndrome: Effects, safety, and cost effectiveness of first and second trimester strategies. BMJ. 322: 423– 436.Google Scholar
Medical Services Advisory Committee 2003 Nuchal translucency measurement in the first trimester of pregnancy for the screening of trisomy 21 and other autosomal trisomies. May 2002 MSAC reference 4 Assessment report. Canberra: Commonwealth of Australia.
Mooney G, Lange M. 1993 Ante-natal screening: What constitutes ‘benefit’? Soc Sci Med. 37: 873– 878.Google Scholar
SABDR (South Australian Birth Defects Register) 1997. 1998 Annual report of the South Australian Birth Defects Register. Adelaide: SABDR;
Snijders RJ, Noble P, Sebire N, et al. 1998 UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10-14 weeks of gestation. Lancet. 352: 343– 346.Google Scholar
Snijders RJ, Sebire NJ, Nicolaides KH. 1995 Maternal age and gestational age-specific risk for chromosomal defects. Fetal Diagn Ther. 10: 356– 367.Google Scholar
Vintzileos AM, Ananth CV, Smulian JC, et al. 2000 Cost-benefit analysis of prenatal diagnosis for Down syndrome using the British or the American approach. Obstet Gynecol. 95: 577– 583.Google Scholar
Wald NJ, Kennard A, Hackshaw A, et al. 1997 Antenatal screening for Down's syndrome. J Med Screen. 4: 181– 246.Google Scholar
Yates JM, Lumley J, Bell RJ. 1995 The prevalence and timing of obstetric ultrasound in Victoria 1991–1992: A population-based study. Aust N Z J Obstet Gynaecol. 35: 375– 379.Google Scholar