Cost-effectiveness of Down syndrome screening paradigms.

Methodologic and ethical concerns in the area of prenatal diagnosis include whether the effects of such testing on individuals other than patients are considered, what assumptions are made regarding termination of pregnancy following a diagnosis, whether the redundancy of screening and diagnostic methods is considered, and how the impact of positive or negative screening results on patient experience and anxiety can be quantified. Several studies have examined the cost-effectiveness of screening for Down syndrome (DS). Given the current test characteristics, screening for DS is cost-effective across a wide variety of clinical situations. In fact, contingent screening is potentially a dominant strategy (costs less and leads to better outcomes). Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies in prenatal diagnosis. Copyright 2010 Elsevier Inc. All rights reserved.