TRADE-OFFS IN PRENATAL DETECTION OF DOWN-SYNDROME

Objectives. This paper presents the results of different screening pol icies for prenatal detection of Down syndrome that would allow decisio n makers to make informed choices. Methods. A decision analysis model was built to compare 8 screening policies with regard to a selected se t of outcome measures. Probabilities used in the analysis were obtaine d from official administrative data reports in Spain and Catalonia and from data published in the medical literature. Sensitivity analyses w ere carried out to test the robustness of screening policies' results to changes in uptake rates, diagnostic accuracy, and resources consume d. Results. Selected screening policies posed major trades-offs regard ing detection rates, false-positive results, fetal loss, and costs of the programs. All outcome measures considered were found quite robust to changes in uptake rates. Sensitivity and specificity rates of scree ning tests were shown to be the most influential factors in the outcom e measures considered. Conclusions. The disclosed trade-offs emphasize the need to comprehensively inform decision makers about both positiv e and negative consequences of adopting one screening policy or anothe r.