The consequences of implementing non-invasive prenatal testing in Dutch national health care: a cost-effectiveness analysis

Beulen, Lean; Grutters, Janneke P.C.; Faas, Brigitte H. W.; Feenstra, Ilse; Vugt, J.M.G. van; Bekker, Mireille N.

doi:10.1016/j.ejogrb.2014.08.028

Cited by 57 publications

(85 citation statements)

References 33 publications

(16 reference statements)

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“…Moreover, costs of invasive testing, a sum of laboratory work and procedure by maternal–fetal medicine specialists, are higher than the cost of NIPT, and this gap is rapidly widening. Health economic consequences of our study will be subject of reviewing 21. Others found similar reductions in invasive testing after introduction of NIPT 1, 22, 23, 24.…”

Section: Discussionmentioning

confidence: 78%

Trial by Dutch laboratories for evaluation of non‐invasive prenatal testing. Part I—clinical impact

et al. 2016

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ObjectiveTo evaluate the clinical impact of nationwide implementation of genome‐wide non‐invasive prenatal testing (NIPT) in pregnancies at increased risk for fetal trisomies 21, 18 and 13 (TRIDENT study).MethodWomen with elevated risk based on first trimester combined testing (FCT ≥ 1:200) or medical history, not advanced maternal age alone, were offered NIPT as contingent screening test, performed by Dutch University Medical laboratories. We analyzed uptake, test performance, redraw/failure rate, turn‐around time and pregnancy outcome.ResultsBetween 1 April and 1 September 2014, 1413/23 232 (6%) women received a high‐risk FCT result. Of these, 1211 (85.7%) chose NIPT. One hundred seventy‐nine women had NIPT based on medical history. In total, 1386/1390 (99.7%) women received a result, 6 (0.4%) after redraw. Mean turn‐around time was 14 days. Follow‐up was available in 1376 (99.0%) pregnancies. NIPT correctly predicted 37/38 (97.4%) trisomies 21, 18 or 13 (29/30, 4/4 and 4/4 respectively); 5/1376 (0.4%) cases proved to be false positives: trisomies 21 (n = 2), 18 (n = 1) and 13 (n = 2). Estimated reduction in invasive testing was 62%.ConclusionIntroduction of NIPT in the Dutch National healthcare‐funded Prenatal Screening Program resulted in high uptake and a vast reduction of invasive testing. Our study supports offering NIPT to pregnant women at increased risk for fetal trisomy. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 78%

Trial by Dutch laboratories for evaluation of non‐invasive prenatal testing. Part I—clinical impact

et al. 2016

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“…There are expectations that the technology will soon become accurate enough to replace current screening methods and diagnostic tests [Norton, Rose and Benn, 2013;Oepkes et al, 2014], as well as predictions that it will be established a new standard of care for prenatal screening [Levine and Goldschlag, 2014]. This would entail numerous benefits, such as eliminating the increased risk of miscarriage associated with invasive tests (e.g., amniocentesis), allowing access to results earlier in the pregnancy, and possibly lowering healthcare expenditure [Song, Musci and Caughey, 2013;Beulen et al, 2014].…”

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confidence: 99%

Media portrayal of non-invasive prenatal testing: a missing ethical dimension

Kamenova¹,

Ravitsky²,

McMullin³

et al. 2016

JCOM

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Non-invasive prenatal testing (NIPT) is an emerging technology for detecting chromosomal disorders in the fetus and mass media may have an impact on shaping the public understanding of its promise and challenges. We conducted a content analysis of 173 news reports to examine how NIPT was portrayed in English-language media sources between January 1 and December 31, 2013. Our analysis has shown that media emphasized the benefits and readiness of the technology, while overlooking uncertainty associated with its clinical use. Ethical concerns were rarely addressed in the news stories, which points to an important dimension missing in the media discourse. AbstractHealth communication; Representations of science and technology

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“…Ayres et al conducted studies in Netherlands to estimate ICER (incremental cost effectiveness ratio) of implementing NIPT, as an optional secondary screening test for high risk pregnancies. They found that the ICER was about k€ 94 per detected case when compared with conventional test alone in health care perspective, and about k€ 460 per detected case when NIPT was implemented alone as a primary screening test [18]. Tan T also found that offering contingent NIPT for high risk patients was cost effective when compared to conventional test with costs per patient of Singapore $ 407 versus 342, but not for performing NIPT with the cost per patient of Singapore $ 1,011 [19].…”

Section: Discussionmentioning

confidence: 99%

Cost Benefit Analysis of Prenatal Screening Test with Thai NIPT (Thai Non- Invasive Prenatal Test) for Down Syndrome in Developing Countries

Oraluck¹,

Boonsong²,

Wasun³

et al. 2017

Health Care Current Reviews

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Objective: The purpose of this study was to assess cost benefits of prenatal screening test for Down syndrome in developing countries (like Thailand) in order to inform OB/GYN clinical practice and medical/public health policy).Methods: A decision tree model was developed to analyze cost-benefits of the two screening modalities versus conventional screening test as base case. The first screening modality was universal Thai NIPT (Thai Non-invasive Prenatal Test) and the second was contingent Thai NIPT. Input parameters related to clinical values and costs were obtained from both primary and secondary sources for Thai population. One-way analysis and probabilistic sensitivity analysis were performed to evaluate uncertainty surrounding model parameters.Results: Based on the societal perspective, performing universal Thai NIPT and contingent Thai NIPT yielded differences of incremental benefit to incremental cost of -4,472 to -3,784 Thai Baht (-127.77 to -108.11 US$) and 396 to 1,085 (11.31 to 31.00 US$) when each was compared to conventional tests. The ratio of incremental benefit to incremental cost was 0.03 to 0.14 for universal Thai NIPT, respectively and thus cost was saved for contingent Thai NIPT. Conclusion:Applying Thai NIPT as the first line of screening for Down syndrome might be cost beneficial if the price was around 4,047 to 4,795 Thai Baht or US$ 115.63 to 137.00 per test. The contingent Down syndrome screening tests by offering the conventional tests first, then followed by Thai NIPT before performing the invasive screening test which seems to be a cost beneficial alternative approach. Currently, there are three methods of NIPT: Shortgun (genomewide) massively parallel sequencing (s-MPS), targeted (t-MPS) and single nucleotide polymorphism (SNP) methods. NIPT is much more accurate than the conventional tests. Previous study reported the Down syndrome detection rate of primary NIPT for all pregnant women is 6-14% higher than the conventional tests with 45-fold FPR (false positive rate.) reduction from meta-analysis [6]. However, the NIPT is still more costly. In order to inform OB/GYN clinical practice and medical/public health policy, this study was conducted to assess the cost benefit of prenatal screening test for Down syndrome with non-invasive prenatal test in developing countries (like Thailand). The Thai NIPT, a not-for-profit service, has been established and wholly processed at Ramathibodi Hospital, Thailand by using s-MPS since 2014 [7]. Cost Benefit Analysis of Prenatal MethodsThis design was a cross-sectional study and cost benefit analysis,

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The consequences of implementing non-invasive prenatal testing in Dutch national health care: a cost-effectiveness analysis

Cited by 57 publications

References 33 publications

Trial by Dutch laboratories for evaluation of non‐invasive prenatal testing. Part I—clinical impact

Trial by Dutch laboratories for evaluation of non‐invasive prenatal testing. Part I—clinical impact

Media portrayal of non-invasive prenatal testing: a missing ethical dimension

Cost Benefit Analysis of Prenatal Screening Test with Thai NIPT (Thai Non- Invasive Prenatal Test) for Down Syndrome in Developing Countries

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