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Value of maternal serum unconjugated oestriol measurement in prenatal screening for Down's syndrome
Author(s) -
Wald Nicholas J.,
Kennard Anne,
Watt Hilary C.,
Smith David
Publication year - 1994
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.1970140809
Subject(s) - medicine , amniocentesis , obstetrics , gestational age , estriol , gestation , ultrasound , fetus , pregnancy , prenatal diagnosis , pediatrics , endocrinology , radiology , genetics , estrogen , biology
We compared the medical and financial cost‐effectiveness of prenatal serum screening for Down's syndrome using maternal age, serum alpha‐fetoprotein and human chorionic gonadotrophin with and without the use of unconjugated oestriol. The use of unconjugated oestriol is medically more cost‐effective than screening without it at all levels of detection. The actual performance depends on whether gestational age is estimated using ‘dates’ or an ultrasound scan. At a detection rate of 60 per cent, the proportion of unaffected fetal losses per case diagnosed at amniocentesis is about 22 per cent less if gestational age is estimated using dates (time since the first day of the last menstrual period) and about 47 per cent less if it is based on an ultrasound scan examination. At this detection rate, the inclusion of unconjugated oestriol increases costs by about £2k per case diagnosed (£36k instead of £34k) if gestational age is estimated using dates, but it is no more expensive if gestational age is measured from an ultrasound scan examination (indeed, it is more cost‐effective at detection rates above 60 per cent). Since there is little change in the financial cost with the inclusion of unconjugated oestriol, for the improved medical performance of screening, it is worthwhile including it in the screening test.