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OVERVIEW 

Clinical and/or cost-effectiveness of first trimester ultrasound screening for fetal anomalies: Is a prospective study an efficient investment?

Screening for fetal anomalies is routinely performed in the second trimester at 18-21 weeks of gestation. Recent data, including a meta-analysis by our group, suggest that screening for fetal anomalies in the first trimester is feasible, and will detect just over half of all prenatally detected anomalies. We have also shown a significant association between the sensitivity of first-trimester ultrasound and the use of an anatomical protocol for screening.

These findings suggest that first trimester anomaly screening has the potential to be a valuable addition to prenatal care for all women. In this project we collaborate with the National Perinatal Epidemiology Unit to evaluate all aspects of screening for fetal anomalies in the first trimester. We will develop planned care pathways by conducting a series of systematic reviews to inform protocol development; undertake a survey of the current screening environment and impact on the National Institute for Health and Care Excellence (NICE) care pathways; conduct a consensus procedure to develop a protocol for the first trimester scanning; conduct an economic analysis and value of information (VoI) study to estimate the expected costs and outcomes associated with current practice and with prospective first trimester anomaly screening protocols. Finally, we will draw together the findings and recommendations from the project, and, if appropriate, outline the design of plausible prospective studies or trials.

Funding: National Institute of Health Research (NIHR) Health Technology Assessment (HTA)