ECONOMIC-ASSESSMENT OF MATERNAL SERUM SCREENING FOR DOWNS-SYNDROME USING HUMAN CHORIONIC-GONADOTROPIN

The effectiveness and costs of prenatal screening programmes for Down' s syndrome using maternal serum markers will vary significantly depend ing on the biological cut-off values chosen in order to select women, at each maternal age, who will be sent for amniocentesis. On the basis of the first French prospective study of human chorionic gonadotropin (hCG) measurement in maternal serum, this paper shows that the screen ing protocol currently used in France, where hCG cut-off values are de fined in order to offer amniocentesis to women of all ages with a 1 pe r cent fetal risk of Down's syndrome, would detect 64.06 per cent of a ll cases of trisomy 21 at birth and would be highly profitable for the French social security system. On the basis of a representative sampl e of 100 000 pregnant women, the total costs of screening would reach $8 302 000 but would generate net potential savings of $32 186 000 in terms of life-long costs of care for trisomic 21 children which would be 'avoided' by termination of pregnancy following a positive diagnosi s of Down's syndrome. Economic assessment shows that cost-benefit anal ysis would justify lower hCG cut-off values and a higher detection rat e of fetal Down's syndrome (74.45 per cent) than the current French pr otocol. This paper concludes that it is ethical and value-laden issues , such as the consequences for women and couples of false positives an d false negatives of screening, rather than economic and financial arg uments that may set limits to the utilization of screening for Down's syndrome using maternal serum markers like hCG.