Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing.
Aust N Z J Obstet Gynaecol
; 57(4): 432-439, 2017 Aug.
Article
em En
| MEDLINE
| ID: mdl-28369759
ABSTRACT
BACKGROUND:
Contingent screening for trisomy 21 using non-invasive prenatal testing has the potential to reduce invasive diagnostic testing and increase the detection of trisomy 21.AIM:
To describe the diagnostic and economic performance of prenatal screening models for trisomy 21 that use non-invasive prenatal testing as a contingent screen across a range of combined first trimester screening risk cut-offs from a public health system perspective.METHODS:
Using a hypothetical cohort of 300 000 pregnancies, we modelled the outcomes of 25 contingent non-invasive prenatal testing screening models and compared these to conventional screening, offering women with a high-risk (1 > 300) combined first trimester screening result an invasive test. The 25 models used a range of risk cut-offs. High-risk women were offered invasive testing. Intermediate-risk women were offered non-invasive prenatal testing. We report the cost of each model, detection rate, costs per diagnosis, invasive tests per diagnosis and the number of fetal losses per diagnosis.RESULTS:
The cost per prenatal diagnosis of trisomy 21 using the conventional model was $51 876 compared to the contingent models which varied from $49 309-66 686. The number of diagnoses and cost per diagnosis increased as the intermediate-risk threshold was lowered. Results were sensitive to trisomy 21 incidence, uptake of testing and cost of non-invasive prenatal testing.CONCLUSION:
Contingent non-invasive prenatal testing models using more sensitive combined first trimester screening risk cut-offs than conventional screening improved the detection rate of trisomy 21, reduced procedure-related fetal loss and could potentially be provided at a lower cost per diagnosis than conventional screening.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Diagnóstico Pré-Natal
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DNA
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Custos de Cuidados de Saúde
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Síndrome de Down
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Medição da Translucência Nucal
Tipo de estudo:
Diagnostic_studies
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Health_economic_evaluation
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Prognostic_studies
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Screening_studies
Limite:
Female
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Humans
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Pregnancy
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article