OBJECTIVES: To assess and compare resource use and direct costs of providing antenatal Down’s syndrome screening and subsequent diagnostic testing for two current screening policies in Northern Ireland.  The first policy provides a universal offer of screening to pregnant women, while the second provides a selective offer of screening, indicated by maternal age ≥35 years, family history and/or maternal request.  METHODS: A retrospective activity analysis was conducted across two health & social care trusts in Northern Ireland.  Data were used to estimate differences in health resource use and costs associated with each offer of serum screening for Down’s syndrome from 2006-2010, inclusive.  A health care trust perspective was employed with local unit costs and United Kingdom reference costs used to weight resource use.  RESULTS: A total of 33,910 women were offered serum screening from 2006-2010: 29,910 under the universal offer of screening and 4,311 under the selective offer of screening.  The uptake rates under the universal and selective screening policies were 10.68% and 14.64%, respectively.  Total costs were calculated as £214,110.41 for implementing the universal offer policy and £18,454.99 for the selective policy; while the average cost per woman of implementing the universal policy was £7.23 and £4.28 for the selective.  CONCLUSIONS: Due to low uptake rates, a universal offer of screening for Down’s syndrome was only moderately more costly, per woman offered, than a selective screening policy.  However, the long term direct and indirect costs and benefits of having a child with Down’s syndrome were not taken into account.  Given the drive of policy towards women’s choice in maternity care, further research is needed to clarify the implications and rationale of providing a selective screening policy for Down’s syndrome, as opposed to a universal policy.