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When marginal costs and benefits should be used in screening

BMJ 1996; 312 doi: (Published 20 April 1996) Cite this as: BMJ 1996;312:1041
  1. Nicholas Wald,
  2. Hilary Watt
  1. Professor Statistician Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Medical College of St Bartholomew's Hospital, London EC1M 6BQ

    EDITOR,—Contrary to the statement by David J Torgerson and Anne Spencer in their article on marginal costs and benefits,1 we did not evaluate the economic consequences of changing screening for Down's syndrome from the method based on maternal age to that based on biochemical screening. We directly estimated the cost of detecting a pregnancy in which the fetus had Down's syndrome by using biochemical screening (the triple test).2

    The example that the authors give of how …

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