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dc.contributor.authorÖkem, Zeynep Güldem
dc.contributor.authorOrgul, Gokcen
dc.contributor.authorKasnakoğlu, Berna Tarı
dc.contributor.authorCakar, Mehmet
dc.contributor.authorBeksac, M. Sinan
dc.identifier.citationÖkem, Z. G., Örgül, G., Kasnakoglu, B. T., Çakar, M., & Beksaç, M. S. (2017). Economic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkey. European Journal of Obstetrics & Gynecology and Reproductive Biology, 219, 40-44.en_US
dc.description.abstractObjectives: To examine the costs and outcomes of different screening strategies for Down Syndrome (DS) in singleton pregnancies. Study design: A decision-analytic model was developed to compare the costs and the outcomes of different prenatal screening strategies. Five strategies were compared for women under 35-year of age: 1A) triple test (TT), 2A); combined test (CT), 3A) Non-invasive Prenatal Screening Test by using cell free fetal DNA (NIPT), 4A) and 5A) NIPT as a second-step screening for high-risk patients detected by either TT, or CT respectively. For women >= 35-year of age, 1B) implementing invasive test (amniocentesis-AC) and 2B) NIPT for all women were compared. Data was analyzed to obtain the outcomes, total costs, the cost per women and the incremental cost-effectiveness ratios (ICERs) for screening strategies. Results: Among the current strategies for women under 35 years old, CT is clearly dominated to TT, as it is more effective and less costly. Although, the current routine practice (2A) is the least-costly strategy, implementing NIPT as a second step screening to high-risk women identified by CT (5A) would be more effective than 2A; leading to a 10.2% increase in the number of detected DS cases and a 96.3% reduction in procedural related losses (PRL). However, its cost to the Social Security Institution that is a public entity would be 17 times higher and increase screening costs by 1.5 times. Strategy 5A would result in an incremental cost effectiveness of 6,873,082 (PPP) US$ when compared to the current one (2A). Strategy 1B-for offering AC to all women >= 35-year of age is dominated over NIPT (2B), as it would detect more DS cases and would be less costly. On the other hand, there would be 206 PRL associated with AC, but NIPT provides clear clinical benefits as there would be no PRL with NIPT. Conclusions: NIPT leads to very high costs despite its high effectiveness in terms of detecting DS cases and avoiding PRL. The cost of NIPT should be decreased, otherwise, only individuals who can afford to pay from out-of-pocket could benefit. We believe that reliable cost-effective prenatal screening policies are essential in countries with low and smiddle income and high birth rates as well. (C) 2017 Elsevier B.V. All rights reserved.en_US
dc.publisherElsevier Science Bven_US
dc.subjectDown syndromeen_US
dc.subjectPrenatal screeningen_US
dc.subjectTriple testen_US
dc.subjectCombined testen_US
dc.subjectNon-invasive prenatal testen_US
dc.subjectEconomic analysisen_US
dc.titleEconomic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkeyen_US
dc.relation.journalEuropean Journal Of Obstetrics & Gynecology And Reproductive Biologyen_US
dc.contributor.departmentTOBB ETU, Faculty of Economics and Administrative Sciences, Department of Managementen_US
dc.contributor.departmentTOBB ETÜ, İktisadi ve İdari Bilimler Fakültesi, İşletme Bölümütr_TR
dc.contributor.tobbetuauthorÖkem, Zeynep Güldem
dc.contributor.tobbetuauthorKasnakoğlu, Berna Tarı
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıtr_TR

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