Cost-effectiveness analysis of triple test in second-trimester maternal serum screening for Down's syndrome: An experience from Taiwan with decreasing birth rate but increasing population of old pregnant women

Hsiao Lin Hwa, Ming Fang Yen, Chen Li Lin, Tsang Ming Ko, Fon Jou Hsieh, Tony Hsiu Hsi Chen

Research output: Contribution to journalArticle

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Objectives: We intended to assess the cost-effectiveness of adding unconjugated oestriol (uE3) in maternal serum screening for Down's syndrome in Taiwan, where there is a decreasing birth rate but an increasing trend of old women having pregnancies. Methods: We used logistic regressions to estimate the risk of Down's syndrome with maternal age and different combinations of biomarkers. Cost-effectiveness analysis was presented in terms of the average and incremental cost-effectiveness ratios. Sensitivity analyses with different parameters were performed. Results: Given a cut-off point of 1:270 for the confirmation of Down's syndrome with amniocentesis, the average cost per case averted for maternal age above 35 years only, double test [alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG)] and triple test (AFP, hCG and uE3) were estimated as $14 561, $42 367 and $37 424. The additional costs per case averted for double test and triple test (compared with maternal age above 35 years) were $135 950 and $77 394, respectively. The additional cost per case averted for triple test was $15 199 compared with double test. Conclusions: The performance of triple test is not only more effective in detecting Down's syndrome cases but also more cost-effective than double test in this study.

Original languageEnglish
Pages (from-to)191-197
Number of pages7
JournalJournal of Evaluation in Clinical Practice
Issue number2
Publication statusPublished - Apr 2008
Externally publishedYes



  • Cost-effectiveness
  • Down's syndrome
  • Maternal serum screening

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Information Management
  • Nursing(all)

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