Cost-benefit Analysis of Prenatal Screening and Diagnosis for Down Syndrome in Thailand - ต้นทุนผลได้ของการตรวจกรองและวินิจฉัยก่อนคลอดของกลุ่มอาการดาวน์ในประเทศไทย

บทคัดย่อ

            This study was aimed at comparing the cost-benefit of prenatal Down syndrome screening and diagnosis of four scenarios in Thailand. Decision-analysis modeling was employed. The societal and government perspectives were used. The results revealed that prenatal Down syndrome screening and confirmation with amniocentesis for every positive test yielded the best value for money. The incremental benefit-to-cost ratio was 1.03 - 1.24 or 73 - 623 baht saved per pregnant woman. The expected number of live births with Down syndrome decreased by half when compared with base case scenario (do nothing). The number of miscarriage from amniocentesis was approximately 100-300 cases per year, and less than other scenario. Additionally, the screening test could be provided in community hospital; as a result, this scenario promotes accessibility of the pregnant women to prenatal screening for Down syndrome. Nevertheless, there were several conditions which should be taken into account when selecting the most suitable screening technique, for example, laboratory capacity, gestation age, and budget. Some negative consequences needed to be borne in mind, for instance, false negative from screening test and risk of miscarriage from amniocentesis procedure.

Key words: Down syndrome, prenatal screening, prenatal diagnosis, Universal Health Coverage Scheme, cost-benefit analysis