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Choosing options for ultrasound screening in pregnancy and comparing cost effectiveness: a decision analysis approach
Author(s) -
Roberts Tracy,
Mugford Miranda,
Piercy James
Publication year - 1998
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1998.tb10258.x
Subject(s) - medicine , cost effectiveness , antenatal screening , cost–benefit analysis , ultrasound , pound (networking) , cost effectiveness analysis , pediatrics , medical physics , obstetrics , pregnancy , risk analysis (engineering) , computer science , radiology , ecology , genetics , biology , world wide web
Objective To compare the cost effectiveness of different programmes of routine antenatal ultrasound screening to detect four key fetal anomalies: serious cardiac anomalies, spina bifida, Down's syndrome and lethal anomalies, using existing evidence. Design Decision analysis was used based on the best data currently available, including expert opinion from the Royal College of Obstetricians and Gynaecologists, Working Party and secondary data from the literature, to predict the likely outcomes in terms of malformations detected by each screening programme. Setting Results applicable in clinics, hospitals or GP practices delivering antenatal screening. Main outcome measure The number of cases with a ‘target’ malformation correctly detected antenatally. Results There was substantial overlap between the cost ranges of each screening programme demonstrating considerable uncertainty about the relative economic efficiency of alternative programmes for ultrasound screening. The cheapest, but not the most effective, screening programme consisted of one second trimester ultrasound scan. The cost per target anomaly detected (cost effectiveness) for this programme was in the range £5,000‐£109,000, but in any 1000 women it will also fail to detect between 3.6 and 4.7 target anomalies. Conclusions The range of uncertainty in the costs did not allow selection of any one programme as a clear choice for NHS purchasers. The results suggested that the overall allocation of resources for routine ultrasound screening in the UK is not currently economically efficient, but that certain scenarios for ultrasound screening are potentially within the range of cost effectiveness reached by other, possibly competing, screening programmes. The model highlighted the weakness of available evidence and demonstrated the need for more information both about current practice and costs.