The cost per detection of a malformed fetus was $40,338 for the MSAFP screening programme; $56,008 for the combined tertiary and non-tertiary centre ultrasound screening programmes. When the ultrasound was performed by tertiary centers, the cost per detected malformed fetus was $29,533, i.e. $10,805 less than MSAFP screening. When the screening ultrasound was performed by non-tertiary centres, the cost per detected fetus was $115,575, i.e. $75,237 more than MSAFP screening. The authors calculated that to maintain the cost per detected malformed fetus using ultrasound at a rate equal to or less than MSAFP screening, physician at the non-tertiary care centres should be reimbursed at a rate of $50 (or less) per examination.