Browsing by Author "Beksac, M. Sinan"

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    Economic Analysis of Prenatal Screening Strategies for Down Syndrome in Singleton Pregnancies in Turkey
    (2017) Okem, Zeynep Culdem; Orgul, Gokcen; Kasnakoglu, Berna Tari; Cakar, Mehmet; Beksac, M. Sinan; 29040895
    Objectives: To examine the costs and outcomes of different screening strategies for Down Syndrome (DS) in singleton pregnancies. Study design: A decision-analytic model was developed to compare the costs and the outcomes of different prenatal screening strategies. Five strategies were compared for women under 35-year of age: 1A) triple test (TT), 2A); combined test (CT), 3A) Non-invasive Prenatal Screening Test by using cell free fetal DNA (NIPT), 4A) and 5A) NIPT as a second-step screening for high-risk patients detected by either TT, or CT respectively. For women >= 35-year of age, 1B) implementing invasive test (amniocentesis-AC) and 2B) NIPT for all women were compared. Data was analyzed to obtain the outcomes, total costs, the cost per women and the incremental cost-effectiveness ratios (ICERs) for screening strategies. Results: Among the current strategies for women under 35 years old, CT is clearly dominated to TT, as it is more effective and less costly. Although, the current routine practice (2A) is the least-costly strategy, implementing NIPT as a second step screening to high-risk women identified by CT (5A) would be more effective than 2A; leading to a 10.2% increase in the number of detected DS cases and a 96.3% reduction in procedural related losses (PRL). However, its cost to the Social Security Institution that is a public entity would be 17 times higher and increase screening costs by 1.5 times. Strategy 5A would result in an incremental cost effectiveness of 6,873,082 (PPP) US$ when compared to the current one (2A). Strategy 1B-for offering AC to all women >= 35-year of age is dominated over NIPT (2B), as it would detect more DS cases and would be less costly. On the other hand, there would be 206 PRL associated with AC, but NIPT provides clear clinical benefits as there would be no PRL with NIPT. Conclusions: NIPT leads to very high costs despite its high effectiveness in terms of detecting DS cases and avoiding PRL. The cost of NIPT should be decreased, otherwise, only individuals who can afford to pay from out-of-pocket could benefit. We believe that reliable cost-effective prenatal screening policies are essential in countries with low and smiddle income and high birth rates as well. (C) 2017 Elsevier B.V. All rights reserved.
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    The Effect of Different Information Sources on The Anxiety Level of Pregnant Women Who Underwent Invasive Prenatal Testing
    (2016) Cakar, Mehmet; Kasnakoglu, Berna Tari; Okem, Zeynep Guldem; Okuducu, Ummuhan; Beksac, M. Sinan; 26867089
    Objective: The goal is to explore the effects of age, education, obstetric history and information sources on the (Beck) anxiety levels of pregnant women attending invasive prenatal testing.Methods: Questionnaire results from 152 pregnant women are utilized. Results are analyzed through an independent samples t-test and a two-step cluster analysis attempting to categorize patients in terms of the chosen variables.Results: t-Tests reveal that age, education and bad obstetric history do not significantly affect anxiety levels. Descriptive statistics indicate that almost 60% of patients feel anxious mostly because of the fear of receiving bad news, followed by the fear of miscarriage, the fear of pain and the fear of hurting the baby. According to the cluster analysis, patients who use doctors or nurses as information sources have significantly lower anxiety levels, while those who do not receive information from any source have the second lowest level of anxiety. Patients who receive information from personal sources (i.e. friends and family) have the highest level of anxiety. Anxiety levels do not change according to test type.Conclusions: Doctors and nurses should allocate enough time for providing information about prenatal diagnosis before the procedure. This will reduce the anxiety level as well as the felt necessity to search for information from other sources, such as personal or popular which will further increase the level of anxiety.