© 1993 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
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An economic appraisal of alternative pre-natal screening programmes for Down's syndrome
P. Shackley, Research Economist
A. McGuire, Reader in Economics
P. A. Boyd, Clinical Coordinator for Prenatal Diagnosis
J. Dennis, Associate Specialist, Childhood Mental Handicap
M. Fitchett, Director of Oxford Medical Genetics Laboratories
J. Kay, Consultant Chemical Pathologist
M. Roche, Community Physician
P. Wood, Consultant Obstetrician and Gynaecologist
Health Economics Research Unit, University of Aberdeen
City University, London and Centre for Socio-Legal Studies, Wolfson College Oxford OX2 6UD
John Radcliffe Maternity Hospital Oxford
Churchill Hospital Oxford
Department of Clinical Biochemistry, John Radcliffe Hospital Oxford
Oxford Regional Health Authority
Kettering General Hospital
Address correspondence to A. McGuire, Centre for Socio-Legal Studies, Wolfson College, Linton Road, Oxford OX2 6UD.
The objective of this study was to evaluate economically a screening programme within the Oxford Regional Health Authority for Down's syndrome, based on maternal serum 
fetoprotein, unconjugated oestriol and human chorionic gonadotrophin as well as maternal age (the triple test) against maternal age alone. The design of the study involved cost-effectiveness analysis of the triple test relative to the maternal age screening programme, and the main outcome measure was the cost per Down's birth avoided. It was found that the triple test is more cost-effective over a wide range of assumptions concerning detection rates and procedure costs. Indirect costs are important in considering the cost-effectiveness of the screening programmes. The most efficient detection rate is around 58 per cent for which the cost per Down's birth avoided is approximately £29600 if only direct costs are evaluated, £20100 if all NHS costs are considered and -£49800 if all resource consequences are analysed. It may be concluded that screening for Down's syndrome using the triple test is cost-effective over a wide range of assumptions concerning detection rate and procedure costs. If all resource costs are considered, the programme is highly cost-effective in comparison with other health care interventions.
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