Economic modelling of antenatal screening and ultrasound scanning programmes for identification of fetal abnormalities
Abstract
Objective Within the framework of a health technology assessment and using an economic model, to determine the most clinically and cost effective policy of scanning and screening for fetal abnormalities in early pregnancy. Design A discrete event simulation model of 50,000 singleton pregnancies. Setting Maternity services in Scotland. Population Women during the first 24 weeks of their pregnancy. Methods The mathematical model was populated with data on uptake of screening, prevalence, detection and false positive rates for eight fetal abnormalities and with costs for ultrasound scanning and serum screening. Inclusion of abnormalities was based on the relative prevalence and clinical importance of conditions and the availability of data. Six strategies for the identification of abnormalities prenatally including combinations of first and second trimester ultrasound scanning and first and second trimester screening for chromosomal abnormalities were compared. Main outcome measures The number of abnormalities detected and missed, the number of iatrogenic losses resulting from invasive tests, the total cost of strategies and the cost per abnormality detected were compared between strategies. Results First trimester screening for chromosomal abnormalities costs more than second trimester screening but results in fewer iatrogenic losses. Strategies which include a second trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected. Conclusions The preferred strategy includes both first and second trimester ultrasound scans and a first trimester screening test for chromosomal abnormalities. It has been recommended that this policy is offered to all women in Scotland.
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Strategies that include a mid-trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected, according to a 2005 cost-effectiveness analysis.
“A 2005 cost-effectiveness analysis concluded that strategies which include a mid-trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected 5 .”
From <scp>ISUOG</scp> Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [5]
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Cited by
Sorted by citations
Salomon, L. J., Alfirevic, Z., Berghella, V., Bilardo, C. M., Chalouhi, G. E., Da Silva Costa, F., Hernandez‐Andrade, E., Malinger, G., Munoz, H., Paladini, D., et al. (2022) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.24888 · Cited by 436 · see citing works
- Authors
- Ritchie, K., Bradbury, I., Slattery, J., Wright, D., Iqbal, K., & Penney, G.
- Affiliations
- University of Ulster (GB)
- University of Plymouth (GB)
- University of Aberdeen (GB)
- Corresponding author
- Ritchie, K.
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2005-05-17
- Volume
- 112
- Issue
- 7
- Pages
- 866-874
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2018403912
- Cited by
- 26
- References
- 43
- Citations by year
- 2025: 1 · 2024: 3 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2013: 1 · 2012: 2
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- prenatal screening, fetal malformations, chromosomal abnormalities, first-trimester screening, second-trimester screening, cost-effectiveness, invasive prenatal diagnosis, discrete event simulation
- MeSH terms
- Chromosome Aberrations, Cost-Benefit Analysis, Female, Fetus, Humans, Models, Biological, Patient Acceptance of Health Care, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Prenatal Diagnosis, Scotland, Ultrasonography, Prenatal
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