Vergelijking van kosten en effecten van prenatale screeningsmethoden voor Down syndroom en neuraalbuisdefecten

The five combinations of parameters in risk estimation for Down syndrome and neural tube defects most likely to be adopted in a Dutch programme for Down syndrome screening, were identified. They were used to perform an analysis of costs and effects. Costs and effects were compared to those of the current Dutch practice (amniocentesis or chorion villus sampling for pregnant women over 36). Two scenarios were evaluated; a scenario where uptake was 50 % of all Dutch pregnant women (about 100.000) and a scenario where uptake was 50% of all pregnant women over 36 years of age (about 14000). Costs and effects were expressed as costs per Down syndrome pregnancy detected and as the ratio of Down syndrome pregnancies detected and pregnancies lost iatrogenically. Costs per Down syndrome pregnancy detected varied between 100.000 euro and 199.000 euro in scenario 1, and between 31.000 euro and 62.000 euro in scenario 2. The ratio of detection and miscarriage varied between 0.2 and 8.7 for scenario 1 and between 0.6 and 23.0 for scenario 2. Total costs varied, depending on the adopted combination of parameters, between 10,2 million euro en 38,0 million euro for scenario 1 and between 1,4 million euro and 5,3 million euro in scenario 2. The parameter combinations based on biochemical analysis in maternal serum perform well considering the costs per detected Down syndrome pregnancy basis. Combinations where one of the parameters is nuchal translucency perform well considering the number of Down syndrome pregnancies detected per iatrogenic miscarriage