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Preference‐sensitive risk‐cutoff values for prenatal‐integrated screening test for Down syndrome
Author(s) -
Yan Jia,
Ayer Turgay,
Keskinocak Pinar,
Caughey Aaron B.
Publication year - 2015
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.4581
Subject(s) - cutoff , medicine , pregnancy , obstetrics , risk assessment , live birth , singleton , prenatal diagnosis , relative risk , gynecology , fetus , confidence interval , physics , biology , computer science , genetics , computer security , quantum mechanics
Objective For a pregnant woman considering prenatal screening for early detection of Down Syndrome (DS), there are at least two major outcomes of interest: undetected DS live births and euploid procedure‐related fetal losses. The risk‐cutoff value of 1/270 has been commonly used for recommending a diagnostic test. The objective of this study was to assess the impact of women's preferences for different pregnancy outcomes on the optimal risk‐cutoff values for integrated screening. Method We built a Monte Carlo simulation model of 100 000 singleton second‐trimester pregnancies to assess the probabilities of DS live births and euploid procedure‐related fetal losses for various risk‐cutoff values. To capture how undesirable some women may view an undetected DS live birth relative to a euploid procedure‐related fetal loss, we used a ratio W 1 : W 2 of weights (penalties) assigned to these two adverse pregnancy outcomes. Results As the relative weight changes, the optimal risk‐cutoff value changes significantly. Conclusion A one‐size‐fits‐all risk‐cutoff value, such as 1/270, may not always be the best choice, depending on the preferences of women. Preference‐sensitive risk‐cutoff values for DS screening have the potential to improve the pregnancy outcomes and patient satisfaction. © 2015 John Wiley & Sons, Ltd.