CHOOSING OPTIONS FOR ULTRASOUND SCREENING IN PREGNANCY AND COMPARING COST-EFFECTIVENESS - A DECISION-ANALYSIS APPROACH

Objective To compare the cost effectiveness of different programmes of routine antenatal ultrasound screening to detect four key fetal anoma lies. serious cardiac anomalies, spina bifida, Down's syndrome and let hal anomalies, using existing evidence. Design Decision analysis was u sed based on the best data currently available, including expert opini on from the Royal College of Obstetricians and Gynaecologists, Working Party and secondary data from the literature, to predict the likely o utcomes in terms of malformations detected by each screening programme . Setting Results applicable in clinics, hospitals or GP practices del ivering antenatal screening. Main outcome measure The number of cases with a 'target' malformation correctly detected antenatally. Results T here was substantial overlap between the cost ranges of each screening programme demonstrating considerable uncertainty about the relative e conomic efficiency of alternative programmes for ultrasound screening. The cheapest, but not the most effective, screening programme consist ed of one second trimester ultrasound scan. The cost per target anomal y detected (cost effectiveness) for this programme was in the range po und 5,000-pound 109,000, but in any 1000 women it will also fail to de tect between 3.6 and 4.7 target anomalies. Conclusions The range of un certainty in the costs did not allow selection of any one programme as a clear choice for NHS purchasers. The results suggested that the ove rall allocation of resources for routine ultrasound screening in the U K is not currently economically efficient, but that certain scenarios for ultrasound screening are potentially within the range of cost effe ctiveness reached by other, possibly competing, screening programmes. The model highlighted the weakness of available evidence and demonstra ted the need for more information both about current practice and cost s.