Colosi E, D'Ambrosio V, Periti E. First trimester contingent screening for trisomies 21,18,13: is this model cost efficient and feasible in public health system?
J Matern Fetal Neonatal Med 2017;
30:2905-2910. [PMID:
27915499 DOI:
10.1080/14767058.2016.1268593]
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Abstract
PURPOSE
To evaluate the effectiveness of three different first trimester screening models for trisomies 21, 18 and 13, in terms of detection rate, invasive test rate and final costs.
MATERIAL AND METHODS
We analyzed the distribution of risk for trisomies 21, 18 and 13 in a population of 20,831 singleton pregnancies based on maternal age, fetal heart rate, nuchal translucency, free beta human chorionic gonadotropin and pregnancy-associated plasma protein A (Combined test). On the basis of our data, we estimated the performance and cost of screening for trisomies using three different models at specific cutoffs: Combined test; Cell free DNA test and Contingent screening test.
RESULTS
Using Combined test, DR for major trisomies was estimated to be 94.92%, invasive test rate was 6.3%. cfDNA would result in a DR of 97.92%, with an invasive test rate of 3.64%. Contingent screening approach would result in an overall DR of 97.82, with a rate for invasive procedure of 1.36% and a final cost lower than other screening policies (2,338,433 euro vs 5,796,060 of cfDNA and 2,385,473 of Combined test).
CONCLUSIONS
Contingent screening test could be a cost-efficient and feasible first trimester screening test for aneuploidies in public health system.
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