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 pregnan...
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| Veröffentlicht in: | Prenatal diagnosis 2013-12, Vol.33 (12), p.1201-1206 |
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| container_title | Prenatal diagnosis |
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| creator | Walker, Brandon Ashwood, Edward R. Jackson, Brian R. Lagrave, Danielle |
| description | 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. |
| doi_str_mv | 10.1002/pd.4225 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1465865016</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1465865016</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3835-eecd035763a52c7bbae7bcd079313d4fe5b8870b35d0ff00e7dac473ed78dc363</originalsourceid><addsrcrecordid>eNp10MtKxDAUBuAgio4XfAMJuFCQai5N01nKeAXxhuIypMkJVtumk7TovL0dZ3QhuDrh5OOH8yO0S8kxJYSdtPY4ZUysoBElY5kQxvgqGhE6vHku6AbajPFtgDkby3W0wVLCJM3GI_R0irugLXjnsG50NYtlxN7hUMZ3bPpu2EfsfMDdK-Bpr23o2wpwhNDXOJoA0Hx_n_mPBsdZY4OvYRutOV1F2FnOLfR8cf40uUpu7i6vJ6c3ieE5FwmAsYQLmXEtmJFFoUEWw0qOOeU2dSCKPJek4MIS5wgBabVJJQcrc2t4xrfQ4SK3DX7aQ-xUXUYDVaUb8H1UNM1EnglC53T_D33zfRgOnivJCKMyFYM6WCgTfIwBnGpDWeswU5SoedGqtWpe9CD3lnl9UYP9dT_NDuBoAT7KCmb_5aj7s2VcstBl7ODzV-vwrjLJpVAvt5dKppOH9PHxQt3zL-rllI0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1472021745</pqid></control><display><type>article</type><title>A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Walker, Brandon ; Ashwood, Edward R. ; Jackson, Brian R. ; Lagrave, Danielle</creator><creatorcontrib>Walker, Brandon ; Ashwood, Edward R. ; Jackson, Brian R. ; Lagrave, Danielle</creatorcontrib><description>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.</description><identifier>ISSN: 0197-3851</identifier><identifier>EISSN: 1097-0223</identifier><identifier>DOI: 10.1002/pd.4225</identifier><identifier>PMID: 24027169</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Abortion, Spontaneous - etiology ; Adult ; alpha-Fetoproteins ; Amniocentesis - adverse effects ; Chorionic Gonadotropin - blood ; Costs and Cost Analysis ; Down Syndrome - blood ; Down Syndrome - diagnosis ; Estriol - blood ; Female ; Gestational Age ; Humans ; Inhibins - blood ; Maternal Age ; Monte Carlo Method ; Pregnancy ; Prenatal Diagnosis - economics ; Prenatal Diagnosis - methods ; Risk Factors</subject><ispartof>Prenatal diagnosis, 2013-12, Vol.33 (12), p.1201-1206</ispartof><rights>2013 John Wiley & Sons, Ltd.</rights><rights>Copyright © 2013 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3835-eecd035763a52c7bbae7bcd079313d4fe5b8870b35d0ff00e7dac473ed78dc363</citedby><cites>FETCH-LOGICAL-c3835-eecd035763a52c7bbae7bcd079313d4fe5b8870b35d0ff00e7dac473ed78dc363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpd.4225$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpd.4225$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24027169$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Walker, Brandon</creatorcontrib><creatorcontrib>Ashwood, Edward R.</creatorcontrib><creatorcontrib>Jackson, Brian R.</creatorcontrib><creatorcontrib>Lagrave, Danielle</creatorcontrib><title>A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome</title><title>Prenatal diagnosis</title><addtitle>Prenat Diagn</addtitle><description>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.</description><subject>Abortion, Spontaneous - etiology</subject><subject>Adult</subject><subject>alpha-Fetoproteins</subject><subject>Amniocentesis - adverse effects</subject><subject>Chorionic Gonadotropin - blood</subject><subject>Costs and Cost Analysis</subject><subject>Down Syndrome - blood</subject><subject>Down Syndrome - diagnosis</subject><subject>Estriol - blood</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Inhibins - blood</subject><subject>Maternal Age</subject><subject>Monte Carlo Method</subject><subject>Pregnancy</subject><subject>Prenatal Diagnosis - economics</subject><subject>Prenatal Diagnosis - methods</subject><subject>Risk Factors</subject><issn>0197-3851</issn><issn>1097-0223</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10MtKxDAUBuAgio4XfAMJuFCQai5N01nKeAXxhuIypMkJVtumk7TovL0dZ3QhuDrh5OOH8yO0S8kxJYSdtPY4ZUysoBElY5kQxvgqGhE6vHku6AbajPFtgDkby3W0wVLCJM3GI_R0irugLXjnsG50NYtlxN7hUMZ3bPpu2EfsfMDdK-Bpr23o2wpwhNDXOJoA0Hx_n_mPBsdZY4OvYRutOV1F2FnOLfR8cf40uUpu7i6vJ6c3ieE5FwmAsYQLmXEtmJFFoUEWw0qOOeU2dSCKPJek4MIS5wgBabVJJQcrc2t4xrfQ4SK3DX7aQ-xUXUYDVaUb8H1UNM1EnglC53T_D33zfRgOnivJCKMyFYM6WCgTfIwBnGpDWeswU5SoedGqtWpe9CD3lnl9UYP9dT_NDuBoAT7KCmb_5aj7s2VcstBl7ODzV-vwrjLJpVAvt5dKppOH9PHxQt3zL-rllI0</recordid><startdate>201312</startdate><enddate>201312</enddate><creator>Walker, Brandon</creator><creator>Ashwood, Edward R.</creator><creator>Jackson, Brian R.</creator><creator>Lagrave, Danielle</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>7TM</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>201312</creationdate><title>A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome</title><author>Walker, Brandon ; Ashwood, Edward R. ; Jackson, Brian R. ; Lagrave, Danielle</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3835-eecd035763a52c7bbae7bcd079313d4fe5b8870b35d0ff00e7dac473ed78dc363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abortion, Spontaneous - etiology</topic><topic>Adult</topic><topic>alpha-Fetoproteins</topic><topic>Amniocentesis - adverse effects</topic><topic>Chorionic Gonadotropin - blood</topic><topic>Costs and Cost Analysis</topic><topic>Down Syndrome - blood</topic><topic>Down Syndrome - diagnosis</topic><topic>Estriol - blood</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Inhibins - blood</topic><topic>Maternal Age</topic><topic>Monte Carlo Method</topic><topic>Pregnancy</topic><topic>Prenatal Diagnosis - economics</topic><topic>Prenatal Diagnosis - methods</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Walker, Brandon</creatorcontrib><creatorcontrib>Ashwood, Edward R.</creatorcontrib><creatorcontrib>Jackson, Brian R.</creatorcontrib><creatorcontrib>Lagrave, Danielle</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Prenatal diagnosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Walker, Brandon</au><au>Ashwood, Edward R.</au><au>Jackson, Brian R.</au><au>Lagrave, Danielle</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome</atitle><jtitle>Prenatal diagnosis</jtitle><addtitle>Prenat Diagn</addtitle><date>2013-12</date><risdate>2013</risdate><volume>33</volume><issue>12</issue><spage>1201</spage><epage>1206</epage><pages>1201-1206</pages><issn>0197-3851</issn><eissn>1097-0223</eissn><abstract>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.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24027169</pmid><doi>10.1002/pd.4225</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Abortion, Spontaneous - etiology Adult alpha-Fetoproteins Amniocentesis - adverse effects Chorionic Gonadotropin - blood Costs and Cost Analysis Down Syndrome - blood Down Syndrome - diagnosis Estriol - blood Female Gestational Age Humans Inhibins - blood Maternal Age Monte Carlo Method Pregnancy Prenatal Diagnosis - economics Prenatal Diagnosis - methods Risk Factors |
| title | A tradeoff analysis of risk cutoffs for the quadruple serum screen for Down syndrome |
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