Clinical and Economic Impact of Adopting Noninvasive Prenatal Testing as a Primary Screening Method for Fetal Aneuploidies in the General Pregnancy Population.
Cell-free DNA; Cost effectiveness; Down syndrome; Economic evaluation; Fetal diagnosis; Genetic testing; Maternal serum screening; Noninvasive prenatal diagnosis; Prenatal screening; Trisomy; Cost-Benefit Analysis; Decision Support Techniques; Female; Humans; Pregnancy; Uncertainty; Aneuploidy; Genetic Testing; Noninvasive Prenatal Testing; Pediatrics, Perinatology and Child Health; Embryology; Radiology, Nuclear Medicine and Imaging; Obstetrics and Gynecology; General Medicine
Abstract :
[en] [en] OBJECTIVE: To evaluate the clinical and economic impact of adopting noninvasive prenatal testing (NIPT) using circulating cell-free DNA as a first-line screening method for trisomy 21, 18, and 13 in the general pregnancy population.
METHODS: A decision-analytical model was developed to assess the impact of adopting NIPT as a primary screening test compared to conventional screening methods. The model takes the Belgium perspective and includes only the direct medical cost of screening, diagnosis, and procedure-related complications. NIPT costs are EUR 260. Clinical outcomes and the cost per trisomy detected were assessed. Sensitivity analysis measured the impact of NIPT false-positive rate (FPR) on modelled results.
RESULTS: The cost per trisomy detected was EUR 63,016 for conventional screening versus EUR 66,633 for NIPT, with a difference of EUR 3,617. NIPT reduced unnecessary invasive tests by 94.8%, decreased procedure-related miscarriages by 90.8%, and increased trisomies detected by 29.1%. Increasing the FPR of NIPT (from < 0.01 to 1.0%) increased the average number of invasive procedures required to diagnose a trisomy from 2.2 to 4.5, respectively.
CONCLUSION: NIPT first-line screening at a reasonable cost is cost-effective and provides better clinical outcomes. However, modelled results are dependent on the adoption of an NIPT with a low FPR.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Chantraine, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR) ; Department of Obstetrics and Gynecology, CHR Citadelle, Liège, Belgium
Di Renzo, Gian Carlo; Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
Language :
English
Title :
Clinical and Economic Impact of Adopting Noninvasive Prenatal Testing as a Primary Screening Method for Fetal Aneuploidies in the General Pregnancy Population.
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