PMID: 9166296May 1, 1997Paper

Cost-effectiveness of strategies used in the evaluation of pregnancies complicated by elevated maternal serum alpha-fetoprotein levels

Obstetrics and Gynecology
A NadelL Wilkins-Haug

Abstract

To perform a cost-effectiveness analysis of various protocols used in the diagnostic evaluation of pregnancies complicated by elevated levels of maternal serum alpha-fetoprotein (MSAFP). The variables incorporated in this model were the prevalence of relevant fetal anomalies; the sensitivity and specificity of MSAFP at 2.0 or 2.5 multiples of the median (MoM); and the sensitivity, specificity, cost, and safety of targeted ultrasound and amniocentesis. We expressed the cost-effectiveness of each strategy as the total cost of the diagnostic evaluation divided by the number of anomalous fetuses identified, yielding the cost per identified anomalous fetus. In a hypothetical cohort of 100,000 singleton pregnancies, a strategy of targeted ultrasound for MSAFP of at least 2.0 MoM detected 90 of 110 structurally abnormal fetuses, without iatrogenic fetal loss, at a cost of $5700 per anomalous fetus. A strategy of amniocentesis with karyo-type determination for MSAFP of at least 2.5 MoM detected 15 additional abnormal fetuses (87 structural abnormalities, ten autosomal aneuploidies, and eight sex chromosomal aneuploidies), with nine iatrogenic fetal losses, at an incremental cost of $46,100 per anomalous fetus. The increased cost and ia...Continue Reading

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Citations

May 1, 2002·Prenatal Diagnosis·Gianluigi Pilu, John C Hobbins
Jan 21, 2003·Prenatal Diagnosis·M JollyP Loughna
Aug 28, 1998·Current Opinion in Obstetrics & Gynecology·R C Reiter
May 17, 2000·Current Opinion in Obstetrics & Gynecology·G PiluL Bovicelli
Oct 29, 2002·Current Opinion in Obstetrics & Gynecology·Kristin Anne BendiksonMark D Hornstein
Feb 5, 2005·Gynecologic and Obstetric Investigation·Aaron B Caughey
Feb 15, 2002·BJOG : an International Journal of Obstetrics and Gynaecology·Tracy RobertsJo Garcia
Mar 9, 2021·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Romain CorroenneMagdalena Sanz Cortes

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