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Economic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkey

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dc.contributor.author Ökem, Zeynep Güldem
dc.contributor.author Orgul, Gokcen
dc.contributor.author Kasnakoğlu, Berna Tarı
dc.contributor.author Cakar, Mehmet
dc.contributor.author Beksac, M. Sinan
dc.date.accessioned 2019-07-03T14:45:15Z
dc.date.available 2019-07-03T14:45:15Z
dc.date.issued 2017
dc.identifier.citation Ökem, 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.identifier.issn 0301-2115
dc.identifier.uri https://doi.org/10.1016/j.ejogrb.2017.09.025
dc.identifier.uri http://hdl.handle.net/20.500.11851/1608
dc.description.abstract Objectives: 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.language.iso eng en_US
dc.publisher Elsevier Science Bv en_US
dc.rights info:eu-repo/semantics/closedAccess
dc.subject Down syndrome en_US
dc.subject Prenatal screening en_US
dc.subject Triple test en_US
dc.subject Combined test en_US
dc.subject Non-invasive prenatal test en_US
dc.subject Cost-effectiveness en_US
dc.subject Economic analysis en_US
dc.subject Amniocentesis en_US
dc.title Economic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkey en_US
dc.type article en_US
dc.relation.journal European Journal Of Obstetrics & Gynecology And Reproductive Biology en_US
dc.contributor.department TOBB ETU, Faculty of Economics and Administrative Sciences, Department of Management en_US
dc.contributor.department TOBB ETÜ, İktisadi ve İdari Bilimler Fakültesi, İşletme Bölümü tr_TR
dc.identifier.volume 219
dc.identifier.startpage 40
dc.identifier.endpage 44
dc.contributor.orcid https://orcid.org/0000-0002-8296-4107
dc.identifier.wos WOS:000418213400007
dc.identifier.scopus 2-s2.0-85031758268
dc.contributor.tobbetuauthor Ökem, Zeynep Güldem
dc.contributor.tobbetuauthor Kasnakoğlu Berna,Tarı
dc.contributor.YOKid 20333
dc.contributor.YOKid 192696
dc.identifier.doi 10.1016/j.ejogrb.2017.09.025
dc.contributor.wosresearcherID M-3850-2019
dc.contributor.ScopusAuthorID 56798593300
dc.contributor.ScopusAuthorID 56845805200
dc.relation.publicationcategory Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı tr_TR


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