BACKGROUND: Currently, noninvasive prenatal testing (NIPT) is only recommended in high-risk women following conventional Down syndrome (DS) screening, and it has not yet been included in the Australian DS screening program. AIMS: To evaluate the cost-effectiveness of different strategies of NIPT for DS screening in comparison with current practice. METHODS: A decision-analytic approach modelled a theoretical cohort of 300,000 singleton pregnancies. The strategies compared were the following: current practice, NIPT as a second-tier investigation, NIPT only in women >35 years, NIPT only in women >40 years and NIPT for all women. The direct costs (low and high estimates) were derived using both health system costs and patient out-of-pocket expenses. The number of DS cases detected and procedure-related losses (PRL) were compared between strategies. The incremental cost per case detected was the primary measure of cost-effectiveness. RESULTS: Universal NIPT costs an additional $134,636,832 compared with current practice, but detects 123 more DS cases (at an incremental cost of $1,094,608 per case) and avoids 90 PRL. NIPT for women >40 years was the most cost-effective strategy, costing an incremental $81,199 per additional DS case detected and avoiding 95 PRL. CONCLUSIONS: The cost of NIPT needs to decrease significantly if it is to replace current practice on a purely cost-effectiveness basis. However, it may be beneficial to use NIPT as first-line screening in selected high-risk patients. Further evaluation is needed to consider the longer-term costs and benefits of screening.
BACKGROUND: Currently, noninvasive prenatal testing (NIPT) is only recommended in high-risk women following conventional Down syndrome (DS) screening, and it has not yet been included in the Australian DS screening program. AIMS: To evaluate the cost-effectiveness of different strategies of NIPT for DS screening in comparison with current practice. METHODS: A decision-analytic approach modelled a theoretical cohort of 300,000 singleton pregnancies. The strategies compared were the following: current practice, NIPT as a second-tier investigation, NIPT only in women >35 years, NIPT only in women >40 years and NIPT for all women. The direct costs (low and high estimates) were derived using both health system costs and patient out-of-pocket expenses. The number of DS cases detected and procedure-related losses (PRL) were compared between strategies. The incremental cost per case detected was the primary measure of cost-effectiveness. RESULTS: Universal NIPT costs an additional $134,636,832 compared with current practice, but detects 123 more DS cases (at an incremental cost of $1,094,608 per case) and avoids 90 PRL. NIPT for women >40 years was the most cost-effective strategy, costing an incremental $81,199 per additional DS case detected and avoiding 95 PRL. CONCLUSIONS: The cost of NIPT needs to decrease significantly if it is to replace current practice on a purely cost-effectiveness basis. However, it may be beneficial to use NIPT as first-line screening in selected high-risk patients. Further evaluation is needed to consider the longer-term costs and benefits of screening.
Authors: Lidia García-Pérez; Renata Linertová; Margarita Álvarez-de-la-Rosa; Juan Carlos Bayón; Iñaki Imaz-Iglesia; Jorge Ferrer-Rodríguez; Pedro Serrano-Aguilar Journal: Eur J Health Econ Date: 2017-12-16
Authors: Jean Gekas; Sylvie Langlois; Vardit Ravitsky; François Audibert; David Gradus van den Berg; Hazar Haidar; François Rousseau Journal: Appl Clin Genet Date: 2016-02-04
Authors: Peter Benn; Kirsten J Curnow; Steven Chapman; Steven N Michalopoulos; John Hornberger; Matthew Rabinowitz Journal: PLoS One Date: 2015-07-09 Impact factor: 3.240
Authors: Lyn S Chitty; David Wright; Melissa Hill; Talitha I Verhoef; Rebecca Daley; Celine Lewis; Sarah Mason; Fiona McKay; Lucy Jenkins; Abigail Howarth; Louise Cameron; Alec McEwan; Jane Fisher; Mark Kroese; Stephen Morris Journal: BMJ Date: 2016-07-04