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Antenatal screening has human costs

  1. Josephine Venn-Treloar, general practice assistant (atreloar@globalnet.co.uk)
  1. The Surgery, Welling, Kent DA16 2JZ
  2. Department of Fetal Medicine, Birmingham Women's Hospital, Birmingham B15 2TG
  3. Queen's Hospital, Burton-on-Trent, Staffordshire DE13 0RB
  4. Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton SO16 5YA
  5. Systematic Reviews Training Unit, Department of Paediatric Epidemiology and Biostatistics,
  6. Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH
  7. Centre for Health Economics, University of York, Heslington, York YO1 5DD
  8. Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  9. Department of Pediatrics, St Stephen's Hospital, Tis Hazari, Delhi 110054, India
  10. Department of Congenital Heart Disease, Guy's Hospital, London SE1 9RT

    EDITOR—In their study Gilbert et al made no provision for the cost of counselling.1 I still hear from women who go for antenatal care and are screened without consent or counselling. 1 2 Some of these women regret entering a conveyor belt process that ends up with an invasive procedure that causes a high rate of fetal loss. Gilbert et al, by highlighting the economic implications of screening, remind us that mothers and their unborn babies continue to be used in what is primarily a cost saving procedure.

    Doubt has already been cast upon the public health benefits of screening and the ethical component of such programmes.3 No pregnancy is replaceable. The cost of screening in human terms has not been evaluated. By excluding the costs of counselling and disregarding mothers' rights and the worth and value to society of children with Down's syndrome, the study by Gilbert et al has severe limitations that should prevent us from embracing such screening strategies.

    References

    1. 1.↵
      1. Gilbert RE,
      2. Augood C,
      3. Gupta R,
      4. Ades AE,
      5. Logan S,
      6. Sculpher M,
      7. et al
      .Screening for Down's syndrome: effects, safety, and cost effectiveness of first and second trimester strategies.BMJ2001;323: 423–425. (25 August.)
      OpenUrlFREE Full Text
    2. 2.↵
      1. J Venn-Treloar J
      .Nuchal translucency-screening without consent.BMJ1998;316: 1026.
      OpenUrlFREE Full Text
    3. 3.↵
      1. Ford C
      .The value of screening for Down's Syndrome in a socio-economically deprived area with a high ethnic population.Br J Obstet Gynaecol1998;105: 855–859.
      OpenUrlMedlineWeb of Science

    Costings are crucial to model

    1. Martin Whittle, chairman, antenatal subgroup of national screening committee (m.j.whittle@bham.ac.uk)
    1. The Surgery, Welling, Kent DA16 2JZ
    2. Department of Fetal Medicine, Birmingham Women's Hospital, Birmingham B15 2TG
    3. Queen's Hospital, Burton-on-Trent, Staffordshire DE13 0RB
    4. Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton SO16 5YA
    5. Systematic Reviews Training Unit, Department of Paediatric Epidemiology and Biostatistics,
    6. Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH
    7. Centre for Health Economics, University of York, Heslington, York YO1 5DD
    8. Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
    9. Department of Pediatrics, St Stephen's Hospital, Tis Hazari, Delhi 110054, India
    10. Department of Congenital Heart Disease, Guy's Hospital, London SE1 9RT

      EDITOR—Gilbert et al in their paper provide an analysis of cost and effectiveness of screening for Down's syndrome using mathematical modelling.1 Costing of procedures undertaken in the NHS is difficult, and Gilbert et al conclude that four screening strategies are cost effective and efficient.

      Nuchal translucency screening is apparently the cheapest procedure, at £4.40 per test, but there is no indication how this figure was derived. In a cost analysis undertaken for ultrasound scanning for the Royal College of Obstetrics and Gynaecology in 1995, the cheapest scan cost about £35.2 This figure was probably unreliable, but the discrepancy is large, and it is important to resolve it since the costs Gilbert et al quote for nuchal translucency screening are crucial to their model. If the costing is inaccurate then the conclusions of the study …

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