A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome

ABSTRACT Objectives In maternal serum screening for Down syndrome, a cutoff of 1 : 270 is often used as a decision point to recommend invasive confirmatory testing. However, it has not been established how well this or any other cutoff relates to patient preferences, that is, the values that pregnant women attach to various screening outcomes. The purpose of this study was to examine the clinical and economic tradeoffs of a wide range of risk cutoffs for the quadruple screen. Methods Screening costs and outcomes for multiple risk cutoffs were modeled using a Monte Carlo simulation. Results The optimal cutoff for maternal serum screening depends on the relative values placed by the patient on different outcomes. Total societal costs were similar across the range of cutoffs. Conclusions Given that different screening outcomes are optimized by different cutoff values, a one‐size‐fits‐all approach may not be appropriate. © 2013 John Wiley & Sons, Ltd. What's already known about this topic? Although it is known that there is preference variation in regard to maternal serum screening outcomes few studies have examined the cost and outcome tradeoffs in regards to risk cutoffs. What does this study add? The current makes such an analysis by modeling a wide range of risk cutoffs for the quadruple serum screen for Down syndrome.