Implementing non-invasive prenatal testing into publicly funded antenatal screening services for Down syndrome and other conditions in Aotearoa New Zealand

Filoche, Sara; Cram, Fiona; Lawton, Beverley; Beard, Angela; Stone, Peter

doi:10.1186/s12884-017-1535-x

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…Public providers only offer tests subsidised by public funding but may feel morally responsible for informing pregnant women about the availability of public tests to provide a ‘better’ antenatal service. Further research is needed to devise a culturally appropriate informed decision-making guideline for NIPT specific to the healthcare system [ 39 , 40 ]. Our finding shows that there is a need for guidelines for public services on making referrals to private services, to provide an optimal antenatal service for all women.…”

Section: Discussionmentioning

confidence: 99%

Service provision of non-invasive prenatal testing for Down syndrome in public and private healthcare sectors: a qualitative study with obstetric providers

Ngan

Ahmed

2018

BMC Health Serv Res

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BackgroundCell-free fetal DNA sequencing based non-invasive prenatal testing (NIPT) for Down syndrome (DS) has become widely available. In Hong Kong, obstetric providers in the public sector refer women identified at high risk of having a child with Down syndrome to obstetric providers in the private sector for NIPT. Little is known about how the NIPT has been adopted in the public sector where DS screening is provided for free of charge. The study aimed to identify the factors influencing providers’ role enactment, such as consultation and referral, in the service provision of NIPT for DS in public and private healthcare sectors.MethodsIn-depth interviews were conducted with 20 obstetric providers offering NIPT in Hong Kong. Thematic narrative analysis was used to identify (i) the factors considered by participants when referring women for NIPT for Down syndrome in public and private healthcare sectors and (ii) their perceptions of the need to integrate NIPT into the current public antenatal service.ResultsParticipants raised concerns about the lack of transparent referral guideline between public and private sectors for NIPT. Public obstetric providers reported little obligation to provide women with much information about risks and benefits of NIPT as it was not provided by public sectors. Some private providers assumed that women referred from the public sector had already received sufficient information about NIPT. The providers were also concerned about potential application of NIPT for further detection without regulation.ConclusionsAlthough the providers had good knowledge of clinical advantages of NIPT over conventional screening, they were uncertain about how to introduce NIPT to women. Guidelines are necessary to enable better coordination of public and private sectors services to enable women to make informed choices about the uptake of NIPT.

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Section: Discussionmentioning

confidence: 99%

Service provision of non-invasive prenatal testing for Down syndrome in public and private healthcare sectors: a qualitative study with obstetric providers

Ngan

Ahmed

2018

BMC Health Serv Res

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“…NIPT has been widely accessible in Aotearoa New Zealand since 2013; however, similar to Australia, it is not covered by the public health system [88]. The Royal Australian and New Zealand College of Obstetricians and Gynecologists acknowledge the use of NIPT for screening trisomies and other foetal genetic conditions during pregnancy; however, screening guidelines or specific regulations have yet to be put in place [47].…”

Section: New Zealandmentioning

confidence: 99%

Non-Invasive Prenatal Testing (NIPT): Reliability, Challenges, and Future Directions

Jayashankar

Nasaruddin

Hassan³

et al. 2023

Diagnostics

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Non-invasive prenatal testing was first discovered in 1988; it was primarily thought to be able to detect common aneuploidies, such as Patau syndrome (T13), Edward Syndrome (T18), and Down syndrome (T21). It comprises a simple technique involving the analysis of cell-free foetal DNA (cffDNA) obtained through maternal serum, using advances in next-generation sequencing. NIPT has shown promise as a simple and low-risk screening test, leading various governments and private organizations worldwide to dedicate significant resources towards its integration into national healthcare initiatives as well as the formation of consortia and research studies aimed at standardizing its implementation. This article aims to review the reliability of NIPT while discussing the current challenges prevalent among different communities worldwide.

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“…In Belgium, cfDNA screening is a first‐tier test where all individuals over 12 weeks' gestation are eligible to receive the funded test . Countries such as Germany, Sweden, Australia, and New Zealand have a self‐pay model where no public funding is currently available . Within Canada, there is variability in cfDNA screening funding models between provinces and territories with seven provinces/territories currently providing some level of public funding for cfDNA screening…”

Section: Introductionmentioning

confidence: 99%

A 2‐year review of publicly funded cell‐free DNA screening in Ontario: utilization and adherence to funding criteria

et al. 2019

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Objective Ontario offers a publicly funded modified contingent model of prenatal screening for aneuploidy in which cell‐free DNA (cfDNA) screening is covered for pregnancies at higher risk of fetal aneuploidy. The objective of this study was to review utilization of provincially funded cfDNA screening and adherence to the criteria laid out in Ontario prenatal screening guidelines. Methods This was a descriptive cohort study using data collected by Ontario's prescribed maternal and child registry. The study population included all pregnant individuals who received cfDNA screening from January 2016 to December 2017. Results The most common criteria for provincially funded cfDNA screening were advanced maternal age ≥40 years (37.7%), positive multiple marker screen (34.1%), modifying risk factors such as ultrasound soft markers (7.1%), and previous aneuploidy (5.5%). The audit demonstrated that 2.9% of funded cfDNA screens tests did not meet funding criteria, and that 11.4% of self‐paid cfDNA screens could have been publicly funded. Conclusion Reviewing and auditing the application of criteria for funded cfDNA screening using prescribed registry data allows an opportunity to identify areas where targeted education may improve adherence to standardized screening protocols, and provides a basis for reassessment of the funding model.

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Implementing non-invasive prenatal testing into publicly funded antenatal screening services for Down syndrome and other conditions in Aotearoa New Zealand

Cited by 7 publications

References 18 publications

Service provision of non-invasive prenatal testing for Down syndrome in public and private healthcare sectors: a qualitative study with obstetric providers

Service provision of non-invasive prenatal testing for Down syndrome in public and private healthcare sectors: a qualitative study with obstetric providers

Non-Invasive Prenatal Testing (NIPT): Reliability, Challenges, and Future Directions

A 2‐year review of publicly funded cell‐free DNA screening in Ontario: utilization and adherence to funding criteria

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