MOMs (multiples of the median) and DADs (discriminant aneuploidy detection): improved specificity and cost-effectiveness of biochemical screening for aneuploidy with DADs

American Journal of Obstetrics and Gynecology
M I EvansR J Sokol

Abstract

Our purpose was to assess the efficacy of double- and triple-screening paradigms for Down syndrome and to develop a more logical, statistical approach to risk prediction that will decrease the cost of screening and allow the incorporation of new parameters appropriately weighted for their contribution. Data from 24,504 patients who had biochemical screening for Down syndrome by single (alpha-fetoprotein), double (alpha-fetoprotein, beta-human chorionic gonadotropin), or triple screening (alpha-fetoprotein, beta-human chorionic gonadotropin, unconjugated estriol) who had complete outcome information were analyzed by (1) existing gaussian-based methods, (2) the Glasgow ratio method, and (3) a new statistical approach (i.e., directly adjusted data sets for discriminant aneuploidy detection [DADs]) By use of individual risk-based thresholds for "at risk" status, both double and triple screening performed far better than single screening, but the percentages of patients at risk varied widely. When the percentages at risk were held constant, the sensitivity of double and triple screenings was similar, suggesting that there are no benefits of using estriol as a third marker. For 25,000 patients the use of only alpha-fetoprotein and be...Continue Reading

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Citations

Oct 28, 1998·American Journal of Obstetrics and Gynecology·A I SokolM I Evans
Aug 14, 2001·Clinics in Perinatology·M I EvansT H Bui
Dec 30, 1996·Early Human Development·G E Palomaki
Apr 29, 1999·Current Opinion in Obstetrics & Gynecology·M I EvansA Johnson
Sep 22, 1998·Clinical Obstetrics and Gynecology·S A Gall
Apr 1, 1996·British Journal of Obstetrics and Gynaecology·J BishopB Nix
Jul 21, 1998·Annals of the New York Academy of Sciences·M I EvansG Critchfield
Oct 26, 2005·Journal of Health Economics·Jane HallJordan J Louviere
Apr 29, 1998·American Journal of Medical Genetics·L B BazzettM I Evans
Jan 1, 1997·Journal of Medical Screening·N J WaldA McGuire
Jan 1, 1995·Journal of Perinatal Medicine·T Chard, M C Macintosh

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