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. Author manuscript; available in PMC: 2017 Jan 30.

Published in final edited form as: Ultrasound Obstet Gynecol. 2014 Jul;44(1):50–57. doi: 10.1002/uog.13287

Cost-effectiveness acceptability curve depicting the percentage of iteration strategies that are cost-effective based on willingness-to-pay per congenital heart disease detected. ………., 4C→MFM, standard screen with second-trimester ultrasound four-chamber view of the heart, with referral to a maternal–fetal medicine (MFM) specialist if abnormal; , 4C→card, standard screen with second-trimester ultrasound of the four-chamber view of the heart, with referral to a pediatric cardiologist if abnormal; , 4C + outflow → MFM, screen with second-trimester ultrasound four-chamber and outflow views of the heart (read by a non-MFM specialist), with referral to an MFM specialist if abnormal; , 4C + outflow → card, screen with second-trimester ultrasound four-chamber and outflow views of the heart (read by a non-MFM specialist), with referral to a pediatric cardiologist if abnormal; , MFM 4C + outflow → card, screen with second-trimester ultrasound four-chamber and outflow views of the heart, interpreted by an MFM specialist and referred to a pediatric cardiologist if abnormal; , NT + outflow, tiered screen with first-trimester nuchal translucency and referral directly for fetal echocardiography if abnormal; if normal, screen with second-trimester ultrasound four chamber and outflow views. , Fetal echo, universal screen with fetal echocardiography.

Inline graphic — Cost-effectiveness acceptability curve depicting the percentage of iteration strategies that are cost-effective based on willingness-to-pay per congenital heart disease detected. ………., 4C→MFM, standard screen with second-trimester ultrasound four-chamber view of the heart, with referral to a maternal–fetal medicine (MFM) specialist if abnormal; , 4C→card, standard screen with second-trimester ultrasound of the four-chamber view of the heart, with referral to a pediatric cardiologist if abnormal; , 4C + outflow → MFM, screen with second-trimester ultrasound four-chamber and outflow views of the heart (read by a non-MFM specialist), with referral to an MFM specialist if abnormal; , 4C + outflow → card, screen with second-trimester ultrasound four-chamber and outflow views of the heart (read by a non-MFM specialist), with referral to a pediatric cardiologist if abnormal; , MFM 4C + outflow → card, screen with second-trimester ultrasound four-chamber and outflow views of the heart, interpreted by an MFM specialist and referred to a pediatric cardiologist if abnormal; , NT + outflow, tiered screen with first-trimester nuchal translucency and referral directly for fetal echocardiography if abnormal; if normal, screen with second-trimester ultrasound four chamber and outflow views. , Fetal echo, universal screen with fetal echocardiography.