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 ,Revised 8 January 2010 ,Accepted 14 January 2010.

  • Image Result

    Decision analytic model

    [+] Indicates subsequent branches of tree are hidden to facilitate display; these branches are similar to those displayed.

    SMA, spinal muscular atrophy.

    Little. The cost-effective

    Decision analytic model

    [+] Indicates subsequent branches of tree are hidden to facilitate display; these branches are similar to those displayed.

    SMA, spinal muscular atrophy.

    Little. The cost-effectiveness of prenatal screening for SMA. Am J Obstet Gynecol 2010.

  • Image Result
    Univariate sensitivity analysisVertical axis displays incremental cost-effectiveness ratio. Columns display changes in cost-effectiveness outcomes while varying each input. Ranges over which each inpu

    Univariate sensitivity analysis

    Vertical axis displays incremental cost-effectiveness ratio. Columns display changes in cost-effectiveness outcomes while varying each input. Ranges over which each input is varied are displayed in Table 1. Horizontal line is drawn at $4.9 million, as this is cost-effectiveness ratio under baseline assumptions.

    LE, life expectancy; QALY, quality-adjusted life year; SAB, miscarriage; SMA, spinal muscular atrophy.

    Little. The cost-effectiveness of prenatal screening for SMA. Am J Obstet Gynecol 2010.

  • Image Result
    Impact of baseline prevalence of spinal muscular atrophyImpact of varying baseline prevalence of disease on incremental cost-effectiveness ratios. Line crosses $100,000 at prevalence of 1 in 1000, $50

    Impact of baseline prevalence of spinal muscular atrophy

    Impact of varying baseline prevalence of disease on incremental cost-effectiveness ratios. Line crosses $100,000 at prevalence of 1 in 1000, $50,000 at prevalence of 1 in 900,and 0 at prevalence of 1 in 800.

    SMA, spinal muscular atrophy.

    Little. The cost-effectiveness of prenatal screening for SMA. Am J Obstet Gynecol 2010.

  • Image Result
    Multivariate sensitivity analysisOutcomes of 100,000 trials from Monte Carlo simulation. Each dot represents single trial outcome. Ellipse represents 95% confidence interval. Dashed line represents wi

    Multivariate sensitivity analysis

    Outcomes of 100,000 trials from Monte Carlo simulation. Each dot represents single trial outcome. Ellipse represents 95% confidence interval. Dashed line represents willingness-to-pay of $100,000. As shown, >99% of points lie above this line, thus are not cost-effective.

    Little. The cost-effectiveness of prenatal screening for SMA. Am J Obstet Gynecol 2010.

 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

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

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