American Journal of Obstetrics & Gynecology
Volume 202, Issue 3 , Pages 253.e1-253.e7, March 2010

The cost-effectiveness of prenatal screening for spinal muscular atrophy

Presented orally at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010, and received the Dru Carlson Award for the Best Abstract in Genetics/Ultrasound.

  • Sarah E. Little, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
    • ,
  • Vanitha Janakiraman, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
    • ,
  • Anjali Kaimal, MD, MAS

      Affiliations

    • Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
    • ,
  • Thomas Musci, MD

      Affiliations

    • San Francisco Perinatal Associates, San Francisco, CA
    • ,
  • Jeffrey Ecker, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
    • ,
  • Aaron B. Caughey, MD, PhD

      Affiliations

    • Decision and Economic Analyses in Reproduction and Women's Health Group and the Center for Clinical and Policy Perinatal Research, University of California, San Francisco, School of Medicine, San Francisco, CA

Received 22 November 2009; received in revised form 8 January 2010; accepted 14 January 2010.

Objective

We sought to investigate the cost-effectiveness of prenatal screening for spinal muscular atrophy (SMA).

Study Design

A decision analytic model was created to compare a policy of universal SMA screening to that of no screening. The primary outcome was incremental cost per maternal quality-adjusted life year. Probabilities, costs, and outcomes were estimated through literature review. Univariate and multivariate sensitivity analyses were performed to test the robustness of our model to changes in baseline assumptions.

Results

Universal screening for SMA is not cost-effective at $4.9 million per quality-adjusted life year. In all, 12,500 women need to be screened to prevent 1 case of SMA, at a cost of $5.0 million per case averted. Our results were most sensitive to the baseline prevalence of disease.

Conclusion

Universal prenatal screening for SMA is not cost-effective. For populations at high risk, such as those with a family history, SMA testing may be a cost-effective strategy.

Key words: cost-effectiveness, decision analysis, prenatal screening, spinal muscular atrophy

 

 Dr Caughey is supported by the Robert Wood Johnson Foundation as Physician Faculty Scholar RWJF-61535.

 Drs Ecker and Caughey served as senior authors.

 Cite this article as: Little SE, Janakiraman V, Kaimal A, et al. The cost-effectiveness of prenatal screening for spinal muscular atrophy. Am J Obstet Gynecol 2010;202:253.e1-7.

 Reprints not available from the authors.

 The racing flag logo above indicates that this article was rushed to press for the benefit of the scientific community.

PII: S0002-9378(10)00062-1

doi:10.1016/j.ajog.2010.01.032

Refers to article:

  • Cross-reference Latest research from the 2010 meeting of the Society for Maternal-Fetal Medicine

    Jay D. Iams
    American Journal of Obstetrics & Gynecology March 2010 (Vol. 202, Issue 3, Page 207)

  • Cross-reference What is the value for money of prenatal carrier screening for spinal muscular atrophy? Too soon to say

    Scott D. Grosse
    American Journal of Obstetrics & Gynecology March 2010 (Vol. 202, Issue 3, Pages 209-211)

American Journal of Obstetrics & Gynecology
Volume 202, Issue 3 , Pages 253.e1-253.e7, March 2010

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