A COMPARATIVE-STUDY OF ROUTINE VERSUS SELECTIVE FETAL ANOMALY ULTRASOUND SCANNING

Objectives-To evaluate the cost-benefit of changing from selective (hi gh risk) to routine ultrasound screening for fetal anomaly. Setting-Wo men booked by general practitioners for primary antenatal care at thei r local hospital. Methods-Prospective study of the 12 months before an d after introduction of routine second trimester ultrasound for fetal anomaly at our institution. All congenital abnormalities, mode of dete ction, and outcome were recorded and a cost analysis of the programme attempted. Results-In the 12 months of selective (high risk) ultrasoun d policy, detailed second trimester scans were performed in 1007 (26%) pregnancies. In the 12 months of routine ultrasound anomaly screening , scans were performed in 3529 (93%) pregnancies. Routine ultrasound w as the sole method of detection for 11 major and 18 less severe congen ital abnormalities found in low risk pregnancies which would not previ ously have qualified for high risk ultrasound. In seven of these cases the parents opted for termination of pregnancy, with estimated saving s on treatment and long term care of pound l 015 546. The financial co st of providing the ultrasound screening service at our hospital for 1 2 months was calculated at pound 57 573 and the resulting financial be nefit for the year was estimated at pound 957 973. Conclusion-Although it is recognised that many of the emotional and psychological costs a nd benefits of the service are difficult to evaluate, routine fetal an omaly ultrasound would seem to be economically justifiable. The financ ial savings achieved at our hospital would translate into a potential annual saving for the National Health Service of nearly pound 170 mill ion if screening were offered in all hospitals in England and Wales.