Recent economic evaluations of antenatal screening: a systematic review and critique

A systematic review of recent economic evaluations of antenatal screening w as conducted. Relevant studies were identified from a number of sources inc luding computerised databases, bibliographies of economic evaluations, and searches of unpublished manuscripts. Each study identified by the literatur e searches was categorised on the basis of its title and abstract. Studies considered relevant to the systematic review were obtained from libraries. The methodology, results, and policy implications of studies categorised as economic evaluations upon full review were documented. A total of 566 studies were identified by the literature searches, 41 of wh ich were categorised as economic evaluations upon full review. The economic evaluations covered a range of antenatal screening practices, aimed mainly at the prevention of infectious diseases and fetal anomalies. The review h ighlighted the poor methodological quality of the bulk of economic evaluati ons of antenatal screening. The study design, data collection methods, and analysis and interpretation of results frequently violated methodological g uidelines adopted by health economists. The review also highlighted the nar row definition of benefits adopted by this body of literature, with most st udies reporting outcomes in terms of cases detected, cases of particular di sorders prevented or, most often, costs averted. The conclusions arrived at differed by area of antenatal screening. There a ppeared to be clear economic arguments in favour of some forms of antenatal screening, for example, triple test screening for Down's syndrome. Other e conomic evaluations pertained to specific locations, which suggests that th e results may not necessarily be generalisable to different settings. For a ll areas of antenatal screening, an updating of published economic evaluati ons may be required to account for evolving economic, epidemiological, and clinical effectiveness evidence.