Economic evaluation of prenatal screening for Down syndrome in the U.S.A.
Maternal serum screening for Down syndrome involves biochemical tests such as alpha-fetoprotein (aFP), human chorionic gonadotrophin (hCG) and unconjugated oestriol (uE3), either alone or in combination, that have variable detection and false-positive rates.
Choosing a screening protocol requires a trade-off between a desired detection rate and an acceptable false-positive rate.
Selecting a screening protocol that maximizes the net benefit to society provides one approach.
We have developed a general formula for calculating the per case net social benefit of a screening test and have applied it to United States data.
The maximum net benefit associated with each of the various screening options currently available is estimated and the model is further applied to determine the conditions under which the addition of a new marker to an existing protocol can be justified.
For each test, or combination of tests, optimal net benefits occur at different detection and false-positive rates.
Net benefits are strongly and positively dependent on maternal age ; high net benefits are associated with older patients and low, or even negative, net benefits with younger patients.
Also, net benefits are affected by the term risk cut-off rate, For triple testing, the 1 : 351 Down syndrome term risk cut-off appears to provide a higher net benefit than that obtained with 1 : 250 or 1 : 300. (...)
Mots-clés Pascal : Mongolisme, Age mère, Analyse coût efficacité, Amniocentèse, Sang, Mère, Analyse statistique, Etude comparative, Etats Unis, Amérique du Nord, Amérique, Incidence, Sensibilité, Spécificité, Femelle, Homme, Diagnostic, Prénatal, Aberration chromosomique, Aneuploïdie, Maladie congénitale, Gestation pathologie, Biologie clinique
Mots-clés Pascal anglais : Down syndrome, Maternal age, Cost efficiency analysis, Amniocentesis, Blood, Mother, Statistical analysis, Comparative study, United States, North America, America, Incidence, Sensitivity, Specificity, Female, Human, Diagnosis, Prenatal, Chromosomal aberration, Aneuploidy, Congenital disease, Pregnancy disorders, Clinical biology
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0076456
Code Inist : 002B20F01. Création : 31/05/1999.