Gilbert and colleagues compared the effects, safety, and cost effectiveness of no screening with nine screening strategies currently available for Down’s syndrome in the UK. Most women are offered the double serum test in the second trimester of their pregnancy.
They found that moving from the double serum test to the first trimester combined test or quadruple test would not cost any more and would detect more fetuses affected by Down’s syndrome. Moving from the double test to the integrated test (the most effective and safest test currently available) would result in fewer affected babies, but would incur additional costs.
The choice of screening strategy should be between the integrated test, first trimester combined test, quadruple test, or measurement of nuchal translucency, say the authors. All other strategies, including the most commonly used test, are more costly and less effective than these four options. These findings clearly have important implications for antenatal practice, they conclude.