1. Analysis of the cost effectiveness of different strategies for the antenatal diagnosis of chromosomal aberrations in cases of ultrasound-identified fetal abnormalities
- Author
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Laurent Gerbaud, Laetitia Gouas, Charline Mourgues, Anne Debost-Legrand, Philippe Vago, Céline Pebrel-Richard, Carole Goumy, Eleonore Eymard-Pierre, H. Laurichesse-Delmas, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), and Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
Adult ,medicine.medical_specialty ,Cost effectiveness ,[SDV]Life Sciences [q-bio] ,Cost-Benefit Analysis ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Ultrasonography, Prenatal ,Single test ,Prenatal ultrasound ,Fetus ,Direct test ,Predictive Value of Tests ,Pregnancy ,Prenatal Diagnosis ,medicine ,Humans ,Positive test ,health care economics and organizations ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,Chromosome Aberrations ,business.industry ,Obstetrics ,Ultrasound ,Decision Trees ,General Medicine ,humanities ,3. Good health ,Fetal Diseases ,Karyotyping ,Cytogenetic Analysis ,Female ,France ,business ,Algorithms ,Cytogenetic Techniques - Abstract
Objective Principal objective of this work was to analyse the cost effectiveness of different sequences of cytogenetic techniques from the hospital's point of view, after prenatal ultrasound has identified fetal malformations. Methods Cytogenetic tests were performed for each case in 3 strategies, and their results are reported and compared to one reference strategy. Two new simulated strategies were considered: chromosomal microarrays alone and a direct test + CMA. Main outcomes measures cost-effectiveness ratio. Results A single test result was positive in 234 of the 835 pregnancies studied (28%). CMA alone would have identified 239 abnormalities. In the simulated direct test + CMA sequence, the direct test alone would have been positive for 66.1% of the abnormalities identified. When testing was indicated for NT, reference strategy (Direct + karyotyping) costs 1 084.8 euros by positive test results. Strategies Direct + CMA and CMA alone cost respectively 992.7 and 550.0 euros by positive test results. For OUM indications, reference strategy costs 2 937.8 euros by positive test results. Strategies Direct + CMA and CMA alone cost respectively, 2 118.4 and 1 304.7 euros by positive test results. Conclusions CMA appears to be the most effective test for prenatal cytogenetic diagnosis of fetal abnormalities identified by ultrasound.
- Published
- 2020
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