%0 Journal Article %A Kyle A. Beauchamp %A Dale Muzzey %A Kenny K. Wong %A Gregory J. Hogan %A Kambiz Karimi %A Sophie I. Candille %A Nikita Mehta %A Rebecca Mar-Heyming %A K. Eerik Kaseniit %A H. Peter Kang %A Eric A. Evans %A James D. Goldberg %A Gabriel A. Lazarin %A Imran S. Haque %T Systematic Design and Comparison of Expanded Carrier Screening Panels %D 2017 %R 10.1101/080713 %J bioRxiv %P 080713 %X Purpose The recent growth in pan-ethnic expanded carrier screening (ECS) has raised questions about how such panels might be designed and evaluated systematically. Design principles for ECS panels might improve clinical detection of at-risk couples and facilitate objective discussions of panel choice.Methods Guided by medical-society statements, we propose a method for the design of ECS panels that aims to maximize the aggregate and per-disease sensitivity and specificity across a range of Mendelian disorders considered serious by a systematic classification scheme. We evaluated this method retrospectively using results from 474,644 de-identified carrier screens. We then constructed several idealized panels to highlight strengths and limitations of different ECS methodologies.Results Based on modeled fetal risks for “severe” and “profound” diseases, a commercially available ECS panel (Counsyl) is expected to detect 183 affected conceptuses per 100,000 US births. A screen’s sensitivity is greatly impacted by two factors: (1) the methodology used (e.g., full-exon sequencing finds more affected conceptuses than targeted genotyping), and (2) the detection rate of the screen for diseases with high prevalence and complex molecular genetics (e.g., fragile X syndrome).Conclusion The described approaches allow principled, quantitative evaluation of which diseases and methodologies are appropriate for pan-ethnic expanded carrier screening. %U https://www.biorxiv.org/content/biorxiv/early/2017/03/03/080713.full.pdf