An Economic Evaluation On Prenatal Screening Strategies For Down’s Syndrome In Hunan Province

Objective:By using the health economics methodology to assess three screening methods of Down’s syndrome (DS) in various age groups in order to provide scientific evidence for the optimum of screening projects for DS.Methods:By collecting data related DS from the Maternal and Child Health Hospital of Hunan Province, field investigation and review of literature, we calculate the disease burden of DS and implement cost-effectiveness, incremental cost-effectiveness, cost-benefit analysis of three screening methods(double marker screening method in the first trimester pregnancy, double marker screening method in the second trimester pregnancy and triple marker screening method in the first trimester pregnancy).We also implement sensitivity analysis to different influential factors.Results:1. Economic burden caused by a new DS birth wilt be1.0998million RMB. Direct economic burden wilt be15.31thousand RMB, accounting for1.39%; indirect economic burden wilt be1.0845million RMB, accounting for98.61%.2. The cost per person of double marker screening method in the first and the second trimester pregnancy, triple marker screening method in the first trimester pregnancy wilt be179.62,169.25,226.50RMB in women of age under35years respectively. The cost per person of those screening projects wilt be370.66,315.10,311.32RMB in women of age above35years respectively.3. The cost-effectiveness analysis ratio(CER) of double marker screening method in the first and the second trimester pregnancy, triple marker screening method in the first trimester pregnancy wilt be168.5,375.4,354.3thousand RMB in women of age under35years respectively. The CER of those screening projects wilt be38.5,30.9,74.8thousand RMB in women of age above35years respectively.4. The net benefit of double marker screening method in the first and the second trimester pregnancy, triple marker screening method in the first trimester pregnancy wilt be730.71,240.31,350.75million RMB, cost-benefit ratio wilt be6.53,2.93,3.10in women of age under35years respectively. The net benefit of those screening projects wilt be633.81,675.26,264.58million RMB, cost-benefit ratio wilt be28.58,35.57,14.71in women of age above35years respectively.5. Parameters of greater impacting on the net benefit are positive rate of screening for Down’s syndrome, examination rate of amniocentesis, positive rate of amniocentesis. The change of the parameters has no effect on the choice of screening projects for DS.Conclusions:1. The economic burden caused by DS is dramatically heavy. It’s necessary to take effective measures to reduce DS births in Hunan Province.2. From the economic point of view, double marker screening method in the first trimester pregnancy is the best project for those under35years, with double marker screening method for those above35years; The effect and efficiency of those above35years is superior to that for the group of age under35years.3. Sensitivity analysis suggest that the results of the evaluation is stable and reliable.