Effects, safety and cost-benefit analysis of Down syndrome screening in first trimester
- Author:
- No author available
- Journal Title:
- Chinese Journal of Obstetrics and Gynecology
- Issue:
- 5
- DOI:
- 10.3760/cma.j.issn.0529-567x.2014.05.002
- Key Word:
- 唐氏综合征;妊娠初期;普查;费用效益分析;Down syndrome;Pregnancy trimester,first;Mass screening;Cost-benefit analysis
Abstract： Objective To investigate the effects,safety and cost-benefit analysis of Down syndrome screening in first trimester.Methods From January 2009 to December 2012,43 729 pregnant women undergoing 3 methods of Down syndrome traditional screening strategies in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively,including in 17 502 cases in pregnancy associated plasma protein A (PAPP-A) and free β-hCG measured biochemistry screening,14 080 cases in nuchal translucency (NT) screening and 12 147 cases in combined screening,meanwhile,7 389 cases on non-invasive fetal trisomy test (NIFTY) were performed in Huada Gene Research Institute(BGI).The effects and safety of four screening strategies were assessed throughout a decision tree.The economical characters of each screening strategy were compared by cost-effectiveness analysis as well as cost-benefit analysis.Results (1) The effects of four strategies are:NIFTY ＞ combined screening ＞ NT screening ＞ biochemistry screening.(2) The safety of four strategies are:NIFTY ＞ combined screening ＞ NT screening ＞ biochemistry screening.(3) Cost-effectiveness analysis and cost-benefit analysis:the biochemistry screening has lowest cost-effectiveness ratio (CER) and highest cost-benefit ratio (CBR),which performed a bettereconomical efficiency.The incremental CER of three traditional screening strategies are all less than the economical burden of Down syndrome.NIFTY has highest CER and negative net present value (NPV),NPV would be positive and CBR would be more than 1 if the price of NIFTY reduce to 1 434 Yuan.Conclusions Combined screening possess best screening efficiency,while biochemistry screening was demonstrated more economical in traditional screening.NIFTY is the future of Down syndrome screening.
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