This is the first meta-analysis using GRADE that shows that NIPT performs well as a screen for trisomy 21 in a general pregnant population. Although the false positive rate is low compared with first trimester combined screening, women should still be advised to confirm a positive result by invasive testing if termination of pregnancy is under consideration.
disease data. In the absence of comparative clinical evidence, Duodopa and Apomorphine were assumed to have equivalent efficacy to DBS. The cost analysis covered: device acquisition, implantation, adverse event management, concomitant drug use, device replacements and follow-up. Cost data were taken from Swedish tariffs, drug list prices and device prices. Costs and QALYs were both discounted at 3% per year. Results: The incremental cost-effectiveness ratio for DBS versus BMT was SEK 387,313 per QALY gained, using a time horizon of 15 years. DBS was predicted to be cost-saving versus Duodopa at 5 years (with a saving of SEK 534,000 per patient) and at 10 years versus Apomorphine. The key parameters in the model were the costs of the DBS device components and the unit costs of the advanced drug therapies. ConClusions: The results suggest that DBS is a cost-effective intervention compared with BMT, based on the informal threshold used in Sweden (SEK 500,000 per QALY gained). When compared against Apomorphine and Duodopa, the high initial costs of DBS equipment and implantation are offset in the long-term by reduced medication costs.
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