Document Detail

Sequential and contingent prenatal screening for Down syndrome.
MedLine Citation:
PMID:  16821246     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the Integrated test in three policies for prenatal Down syndrome screening: Integrated screening for all women, sequential screening (first-trimester tests allowing early completion of screening for high-risk pregnancies), and Contingent screening (early completion of screening for high- and low-risk pregnancies). DESIGN AND METHODS: Estimation of detection rates (DRs) and false-positive rates (FPRs) using Monte Carlo simulation and cost effectiveness for each method. SETTING AND POPULATION: Down syndrome affected and unaffected pregnancies studied in the Serum Urine and Ultrasound Screening Study (SURUSS). RESULTS AND MAIN OUTCOMES: Integrated screening has the best screening performance. The performance of the other two policies approached that of Integrated screening as the first-trimester test FPR decreased. If the first-trimester FPR is set to 0.5% (risk >or= 1 in 30) with an overall DR of 90%, sequential and contingent screening yield overall FPRs of 2.25% and 2.42%, respectively, and 66% of the affected pregnancies are detected by the first-trimester test. The Integrated test on all women yields an FPR of 2.15%. With sequential screening, 99.5% of women would proceed to an Integrated test, or 30% with contingent screening if those with first-trimester test risks of <or=1 in 2000 are classified screen-negative and receive no further testing. About 20% of affected pregnancies identified in the first trimester using sequential or contingent screening would have unnecessary terminations (they would miscarry before the early second trimester). Contingent screening is the most cost-effective if there is no alphafetoprotein screening for neural tube defects, otherwise Integrated screening is more cost-effective. CONCLUSIONS: Integrated screening for all women is the simplest, most effective, and the safest policy. Contingent screening is the most complex with the lowest screening performance. Making an earlier diagnosis with sequential and contingent screening has adverse consequences that are sufficient to discourage their use.
Nicholas J Wald; Alicja R Rudnicka; Jonathan P Bestwick
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Prenatal diagnosis     Volume:  26     ISSN:  0197-3851     ISO Abbreviation:  Prenat. Diagn.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-04     Completed Date:  2006-12-28     Revised Date:  2007-04-03    
Medline Journal Info:
Nlm Unique ID:  8106540     Medline TA:  Prenat Diagn     Country:  England    
Other Details:
Languages:  eng     Pagination:  769-77     Citation Subset:  IM    
Wolfson Institute of Preventive Medicine, Barts and the London Queen Mary's School of Medicine and Dentistry, London EC1M 6BQ, UK.
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MeSH Terms
Cost-Benefit Analysis
Down Syndrome / diagnosis*,  economics
False Positive Reactions
Mass Screening / methods*
Maternal Age
Monte Carlo Method
Pregnancy Trimester, First
Prenatal Diagnosis / economics,  methods*
Risk Assessment
Sensitivity and Specificity
Comment In:
Prenat Diagn. 2007 Feb;27(2):186-7   [PMID:  17266162 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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