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  • A cost-effectiveness analysis comparing different strategies to implement noninvasive prenatal testing into a Down Syndrome screening program

    Author(s)
    Ayres, Alice C
    Whitty, Jennifer A
    Ellwood, David A
    Griffith University Author(s)
    Ellwood, David A.
    Year published
    2014
    Metadata
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    Abstract
    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. ...
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    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.
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    Journal Title
    Australian and New Zealand Journal of Obstetrics and Gynaecology
    Volume
    54
    Issue
    5
    DOI
    https://doi.org/10.1111/ajo.12223
    Subject
    Medical and Health Sciences not elsewhere classified
    Paediatrics and Reproductive Medicine
    Public Health and Health Services
    Publication URI
    http://hdl.handle.net/10072/65508
    Collection
    • Journal articles

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