A cost-effectiveness analysis of prenatal screening strategies for Down syndrome

Anthony O. Odibo, David M. Stamilio, Deborah B. Nelson, Harish M. Sehdev, George A. Macones

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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.

Original languageEnglish
Pages (from-to)562-568
Number of pages7
JournalObstetrics and gynecology
Issue number3
StatePublished - Sep 2005

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    Odibo, A. O., Stamilio, D. M., Nelson, D. B., Sehdev, H. M., & Macones, G. A. (2005). A cost-effectiveness analysis of prenatal screening strategies for Down syndrome. Obstetrics and gynecology, 106(3), 562-568. https://doi.org/10.1097/01.AOG.0000174581.24338.6f