Amy Flick1, Deborah Krakow2, Anahit Martirosian3, Neil Silverman4, Lawrence D Platt5. 1. Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA. 2. Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA; Department of Human Genetics and Orthopedic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA; Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA. 3. Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA. 4. Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA; Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA. 5. Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA; Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA. Electronic address: ldplatt@gmail.com.
Abstract
OBJECTIVE: The objective of the study was to evaluate whether the current screening regimen of measuring amniotic fluid alpha-fetoprotein (AF-AFP) at the time of amniocentesis and reflex acetylcholinesterase testing vs ultrasound alone to detect neural tube and ventral wall defects offers improved diagnostic accuracy and cost benefit. STUDY DESIGN: A retrospective chart review on all patients who had amniocentesis performed at 1 center over the past 11 years was performed. Those with an elevated AF-AFP were compared with those whose AF-AFP was within normal limits. Ultrasound findings and outcomes were reviewed in all cases to assess whether neural tube defects (NTDs) or ventral wall defects (VWDs) were missed by AF-AFP or ultrasound screening. A cost-benefit analysis was then performed. RESULTS: Of 6232 women who underwent amniocentesis between January 2002 and December 2012, 81 had an elevated AF-AFP with or without a positive acetylcholinesterase (AChE). Of these 81 women, 13 had NTDs and 5 had VWDs. The sensitivity of the detailed ultrasound was 100% in detecting NTDs and VWDs, whereas that of the AF-AFP ranged from 22% to 77%, with the inclusion of AChE. The total expenditure for AF-AFP in our sample set (n = 6232 amniocentesis at $76.00 per AF-AFP) was $473,632, and all NTDs and VWDs were detected by ultrasound. Translated to a national laboratory (>42,447 samples/year), the cost savings in 2011 alone would be $3,225,972. CONCLUSION: Given the accuracy of high-resolution ultrasound in the detection of both NTDs and VWDs, measuring AF-AFP and AChE as a reflex-screening test is not a cost-effective approach.
OBJECTIVE: The objective of the study was to evaluate whether the current screening regimen of measuring amniotic fluid alpha-fetoprotein (AF-AFP) at the time of amniocentesis and reflex acetylcholinesterase testing vs ultrasound alone to detect neural tube and ventral wall defects offers improved diagnostic accuracy and cost benefit. STUDY DESIGN: A retrospective chart review on all patients who had amniocentesis performed at 1 center over the past 11 years was performed. Those with an elevated AF-AFP were compared with those whose AF-AFP was within normal limits. Ultrasound findings and outcomes were reviewed in all cases to assess whether neural tube defects (NTDs) or ventral wall defects (VWDs) were missed by AF-AFP or ultrasound screening. A cost-benefit analysis was then performed. RESULTS: Of 6232 women who underwent amniocentesis between January 2002 and December 2012, 81 had an elevated AF-AFP with or without a positive acetylcholinesterase (AChE). Of these 81 women, 13 had NTDs and 5 had VWDs. The sensitivity of the detailed ultrasound was 100% in detecting NTDs and VWDs, whereas that of the AF-AFP ranged from 22% to 77%, with the inclusion of AChE. The total expenditure for AF-AFP in our sample set (n = 6232 amniocentesis at $76.00 per AF-AFP) was $473,632, and all NTDs and VWDs were detected by ultrasound. Translated to a national laboratory (>42,447 samples/year), the cost savings in 2011 alone would be $3,225,972. CONCLUSION: Given the accuracy of high-resolution ultrasound in the detection of both NTDs and VWDs, measuring AF-AFP and AChE as a reflex-screening test is not a cost-effective approach.
Authors: Waldo Sepulveda; Amy E Wong; Francisco Sepulveda; Juan L Alcalde; Juan C Devoto; Felipe Otayza Journal: Childs Nerv Syst Date: 2017-06-07 Impact factor: 1.475