OBJECTIVE: The objective of this study was to perform a cost-benefit analys
is of routine second-trimester screening ultrasonography in the United Stat
es as compared with performing ultrasonography only in the presence of indi
cations.
STUDY DESIGN: It was assumed that 1 million pregnant women are available an
nually who otherwise would not have an indication for an ultrasonographic e
xamination. Cost savings from early detection and therapeutic abortion were
considered only for fetal conditions for which lifetime cost estimates are
available, including spina bifida, major cardiac disease, cleft lip or pal
ate, renal agenesis or dysgenesis, urinary obstruction, lower or upper limb
reduction, omphalocele, gastroschisis, and diaphragmatic hernia. Two separ
ate cost-benefit analyses were considered with the range of fetal anomaly d
etection rates before 24 weeks' gestation as reported by tertiary and non-t
ertiary centers in the Routine Antenatal Diagnostic Imaging with Ultrasound
(RADIUS) trial. Potential cost savings from averting treatment for preterm
labor and postdate gestations were also considered.
RESULTS: The ratio of savings to cost was between 1.35 and 1.70 (savings of
$1.35-$1.70 per $1 spent) if the ultrasonographic examinations were perfor
med in tertiary care centers. The ratio of savings to cost was between 0.40
and 0.74 (loss of $0.26-$0.60 per $1 spent) if the examinations were perfo
rmed in nontertiary centers. If the screening ultrasonography was performed
in tertiary centers, the expected annual net benefits were estimated at $9
7 to 189 million. If ultrasonographic screening was performed in nontertiar
y centers, the expected annual net losses were estimated at $69 to 161 mill
ion.
CONCLUSION: Routine second-trimester ultrasonographic screening appears to
be associated with net benefits only if the ultrasonography is performed in
tertiary care centers.