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A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States.

Walker BS, Nelson RE, Jackson BR, Grenache DG, Ashwood ER, Schmidt RL - PLoS ONE (2015)

Bottom Line: Contingent NIPT may provide a cost-effective alternative to universal NIPT screening.From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT.When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS.

View Article: PubMed Central - PubMed

Affiliation: ARUP Laboratories, Salt Lake City, Utah, United States of America.

ABSTRACT

Background: Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS.

Study design: Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer.

Results: From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective.

Conclusions: From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS.

No MeSH data available.


Related in: MedlinePlus

Decision tree diagram for MSS.The decision tree is continued in the diagnostic testing tree (Fig 4).
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pone.0131402.g003: Decision tree diagram for MSS.The decision tree is continued in the diagnostic testing tree (Fig 4).


A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States.

Walker BS, Nelson RE, Jackson BR, Grenache DG, Ashwood ER, Schmidt RL - PLoS ONE (2015)

Decision tree diagram for MSS.The decision tree is continued in the diagnostic testing tree (Fig 4).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4489811&req=5

pone.0131402.g003: Decision tree diagram for MSS.The decision tree is continued in the diagnostic testing tree (Fig 4).
Bottom Line: Contingent NIPT may provide a cost-effective alternative to universal NIPT screening.From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT.When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS.

View Article: PubMed Central - PubMed

Affiliation: ARUP Laboratories, Salt Lake City, Utah, United States of America.

ABSTRACT

Background: Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS.

Study design: Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer.

Results: From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective.

Conclusions: From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS.

No MeSH data available.


Related in: MedlinePlus