Reliability, Accuracy and Cost-effectiveness of Prenatal Screening Tests

Abstract

Nowadays in most countries worldwide and in Albania as well, it has become standard in prenatal care to offer screening tests for neural tube defects and genetic abnormalities. There have been some changes in the recommended method of prenatal screening over the past few years, and research to improve detection rates with better combinations of maternal serum analytes is ongoing.

Up to recent years there was mostly in use ultrasound examination of the fetus combined with double, triple and quadruple test as non invasive screening test, followed by diagnostic test like amniocentesis, chorionic villus sampling, cordocentesis when need to confirm the diagnosis. In the past 4 years there have been introduced other tests named; harmony, panorama, verify and materniT21, that are grouped as non invasive prenatal test (NIPT) or known as well as non invasive prenatal screening (NIPS), when the testing was being developed, it was thought it would be diagnostic. However, it still had false positives and false negatives, rendering it not a diagnostic test, but a screening test. As the science and technology advance in clinical practical basis we look not only to reliability but also at the cost-effectiveness of these prenatal screenings. Whereas in developed countries with well functioning health care system, prenatal screening test are covered, in Albania such prenatal screening tests are contemporaneous choices of pregnancy care with up to date information provided by obstetrician, nevertheless, the expenditure of these tests remain uncovered by our health care system therefore these costs remain part of patient’s personal budget.

In conclusion, application of prenatal screening test and obstetrical ultrasound examination are very important to be in use for every pregnant woman. In Albania, this can be done as part of high standard of care only when medical protocols, reliability and cost-effectiveness of these tests are part of integral promotion under service of national health care for an excellence care during pregnancy.

Keywords: Prenatal screening, genetic abnormalities, reliability, cost-effectiveness