Maternal serum alpha-fetoprotein screening: a cost-benefit analysis

Abstract

The prenatal detection of fetal neural tube defects (NTD) is now possible by means of a multi-tiered program utilizing maternal serum alpha-fetoprotein (MSAFP) screening coupled with ultrasonography and amniocentesis where indicated. This paper considers the economic consequences of screening for fetal NTD a theoretical cohort of 100,000 pregnant women at risk of having an affected fetus who would elect to terminate their pregnancies if an affected fetus were found. The cost of the program was balanced against the benefits of the program, such as the averted costs of institutionalization, medical care, and the like. The total cost of the program to screen 100,000 such women was calculated to be $2,047,780, or slightly over $20 per woman screened, while the total economic benefits exceeded $4,000,000.

PIP: Neural tube defects in prepartum fetuses can be detected by a three-part program using maternal serum alpha fetoprotein (AFP) screening with ultrasonography and amniocentesis when indicated. The economic consequences of screening for a hypothetical cohort of 100,000 pregnant women were measured against the benefits to be accrued from the program. If defective pregnancies were terminated the institutional and medical costs of care would be avoided. The total cost of screening 100,000 women was estimated to be $2,047,780, slightly over $20 per woman. The economic benefits exceeded $4,000,000. Ethical questions surrounding alpha fetoprotein (AFP) screenings still remain. A pilot program to study cost-benefits under real life conditions is recommended.