Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-24T12:25:12.909Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness analysis of prenatal diagnosis intervention for Down's syndrome in China

Published online by Cambridge University Press:  18 January 2007

Yingyao Chen ,
Xu Qian ,
Jun Li ,
Jie Zhang ,
Annie Chu  and
Stuart O. Schweitzer
Yingyao Chen
Affiliation:
Fudan University
Xu Qian
Affiliation:
Fudan University
Jun Li
Affiliation:
Fudan University
Jie Zhang
Affiliation:
Fudan University
Annie Chu
Affiliation:
Fudan University
Stuart O. Schweitzer
Affiliation:
UCLA School of Public Health
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The cost-effectiveness of prenatal diagnosis intervention for Down's syndrome (DS) in China was assessed and evidence-based information for policy makers and providers is presented.

Methods: Based on field surveys in four selected cities in China and a literature review, the economic evaluation of prenatal diagnosis for DS from a societal perspective is conducted by cost-effectiveness analysis.

Results: In current clinical practice, for a cohort of 10,000 pregnant women, the strategy that delivers karyotyping by chorionic villus sampling (CVS) or amniocentesis (AC) only to those pregnant women 35 years of age and older (maternal age screening strategy) can detect .67 DS births. The strategy that offers the diagnostic test after maternal serum screening with α-fetoprotein and human chorionic gonadotrophin (maternal serum screening strategy) can detect 1.41 DS births. The cost per prevented DS birth by the maternal age screening strategy and maternal serum screening strategy is US$13,091 and US$56,048, respectively. Sensitivity analysis shows that the maternal serum screening strategy can be cost-effective if uptake rate of CVS or AC for patients with positive serum tests increase while the cost of serum screening decreases.

Conclusions: Although, in general, serum screening has been found to be more cost-effective than maternal age screening, this appears not to be the case in China. The reasons appear to be low uptake rate of the maternal serum strategy, low uptake rate of CVS or AC, and the high price of serum screening. Our findings are that health system factors concerning technology utilization are important determinants of the technology's efficiency.

Keywords

Cost-effectiveness analysisPrenatal diagnosisDown's syndrome
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 1 , January 2007 , pp. 138 - 145
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bao JF, Zeng PP, Shao Y. 2004 Screening for Down's syndrome by maternal serum makers. J Qiqihar Med Coll. 25: 259– 260.Google Scholar
Cao ZS, Gou WL. 2000: Modern obstetrics. 1st ed. Beijing: People's Health Press; 34– 161.
Chao AS, Chung CL, Wu CD, et al. 1999 Second trimester maternal serum screening using alpha fetoprotein, free beta human chorionic gonadotropin and maternal age specific risk: Result of chromosomal abnormalities detected in screen positive for Down's syndrome in an Asian population. Acta Obstet Gynecol Scand. 78: 393– 397.Google Scholar
Chen LQ, Wang W. 2003 Birth surveillance analysis in the year of 1986 and 2001 in Dongcheng District in Beijing. Dis Surveill. 18: 26– 27.Google Scholar
Chen YY, Qian X, Tang ZL, et al. 2004. Situation analysis of prenatal diagnosis technology utilization in China: Current situation, main issues and policy implications. Int J Technol Assess Health Care. 20: 524– 530.Google Scholar
Chen YY, Huang W, Du L, Tang ZL, Qian X. 2005. Current situation of premarital care and countermeasures in China. Natl Key Lab Health Technol Assess.Google Scholar
Fletcher J, Hicks NR, Kay JDS, Boyd PA. 1995 Using decision analysis to compare policies for antenatal screening for Down's syndrome. BMJ. 311: 351– 356.Google Scholar
Gilbert RE, Augood C, Gupta R, et al. 2001 Screening for Down syndrome: Effects, safety and cost-effectiveness of first and second trimester strategies. BMJ. 323: 423– 425.Google Scholar
Glasson EJ, Sullivan SG, Hussain R, et al. 2002 The changing survival profile of people with Down's syndrome: Implications for genetic counseling. Clin Genet. 62: 390– 393.Google Scholar
Hu WS, Chen ML. 2003 Screening for Down's syndrome and NTD. Zhejiang Prev Med. 15: 34.Google Scholar
Lam YH, Ghosh A, Tang MH, et al. 1998 Second-trimester maternal serum alpha-fetoprotein and human chorionic gonadotrophin screening for Down's syndrome in Hong Kong. Prenat Diagn. 18: 585– 589.Google Scholar
Li J, Chen YY, Chen J, Zhang J, Qian X. 2005 Study on standard cost of prenatal diagnosis on Down's syndrome. Chin Health Resources. 8: 121– 122.Google Scholar
Lin AH, Wu JM, Jiang W, Li ZH, Ye PT. 2000 Study of prenatal diagnosis for Down's syndrome by AFP and HCG in the second trimester. China Maternal Child Health. 15: 258– 259.Google Scholar
Liu B, Gao ES. 2002 Risk factors for spontaneous abortion of Chinese married women at reproductive age. China Public Health. 18: 890– 892.Google Scholar
Liu JT, Hao N, Sun NH, et al. 2003 Screening by maternal serum markers for Down's syndrome. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 25: 156– 159.Google Scholar
National Bureau of Statistics of China. China statistical yearbook 2004. Available at: http://www.stats.gov.cn.
Roizen NJ, Patterson D. 2003 Down's syndrome. Lancet. 361: 1281– 1289.Google Scholar
Sun DG, Jiang YT, Li X. 2003 Prenatal screening study by maternal serum screening with AFP and HCG in the second trimester. China J Fam Plann. 11: 674– 676.Google Scholar
Tabor A, Madsen M, Obel EB, et al. 1986 Randomized controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet. 1: 1287– 1293.Google Scholar
Tian GL, Cao QX, Zhu WM, Dong QY. 2000 Prenatal screening for Down's syndrome and certain fetal defects. Sh J Prev Med. 12: 212– 213.Google Scholar
Wald NJ, Walters J, Rodeck C, et al. 2003 First and second trimester antenatal screening for Down's syndrome: The results of the serum, urine and ultrasound screening study. Health Technol Assess. 7: 1.Google Scholar
Wald NJ, Kennard A, Hackshaw A, McGuire A. 1998 Antenatal screening for Down's syndrome. Health Technol Assess. 2: 75– 84.Google Scholar
Wen YB, Chen KC, Xiao XF, Li XH. 2001 Birth surveillance anal- ysis between 1990-1999 in Shantou City. Dis Surveill. 16: 782– 783.Google Scholar
Wertz DC, Fletcher JC, Berg K. 2001: Review of ethical issues in medical genetics. World Health Organization Human Genetic Program 62– 64.
World Atlas of Birth Defects. 2003: 2nd ed. Geneva: WHO; 151– 153.
Yan YL. Prenatal ultrasound diagnosis. 1st ed. Beijing: People's Health Press; 2003: 440– 443.
Yu KM, Wang TF, Zhong HL, Yang HZ. 2002 The feasibility study of maternal serum screening strategy for Down's syndrome with AFP and free HCG in the second trimester. Chin J Obstet Gynecol. 37: 691– 692.Google Scholar
Zhang XJ, Dai OH. 2004 Serum screening for Down's syndrome in the second trimester. China Gene. 12: 37– 38.Google Scholar
Zhuo LW, Liao C, Song SB, Tu XZ. 2004 The study of prenatal screening for Down's syndrome. China Pract Obstet Gynecol. 20: 414– 416.Google Scholar