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

Abstract

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. Screening costs and outcomes for multiple risk cutoffs were modeled using a Monte Carlo simulation. 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. Given that different screening outcomes are optimized by different cutoff values, a one-size-fits-all approach may not be appropriate.