Cost-Effectiveness Analysis of Non-invasive Prenatal Testing for Down Syndrome in China

2019 ◽  
Vol 35 (03) ◽  
pp. 237-242 ◽  
Author(s):  
Yan Xu ◽  
Yan Wei ◽  
Jian Ming ◽  
Na Li ◽  
Ningze Xu ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Cost Effectiveness ◽  
Pregnant Women ◽  
Universal Screening ◽  
Prenatal Testing ◽  
Screening Strategy ◽  
Decision Analytic Model ◽  
Cost Effectiveness Ratio ◽  
Non Invasive ◽  
The Cost

AbstractObjectivesThere is little evidence in China regarding the cost-effectiveness of non-invasive prenatal testing (NIPT) for Down syndrome (DS). This study aims to evaluate the cost-effectiveness of NIPT and provide evidence to inform decision-making.MethodsTo determine the cost-effectiveness of NIPT for DS, a decision-analytic model was developed using the TreeAge Pro software from a societal perspective in a simulated cohort of 10 000 pregnant women. Main indicators were based on field surveys from sampled hospitals in four locations in China and a literature review.ResultsThe conventional maternal serum screening (CMSS) strategy, contingent screening strategy (NIPT delivered to high risk pregnant women after CMSS), and universal screening strategy could prevent 3.02, 7.53, and 9.97 DS births, respectively. NIPT would decrease unnecessary invasive procedures, resulting in fewer procedure-related miscarriages. The cost-effectiveness ratio of the contingent screening strategy was the lowest. When compared with the CMSS strategy, the incremental cost per DS birth averted by the contingent screening strategy and universal screening strategy were USD 20,160 and 352,388, respectively. One-way sensitivity analysis showed that, if the cost of NIPT could be decreased to USD 76.92, the cost-effectiveness ratio of the universal screening strategy would be lower than the CMSS strategy.ConclusionsAlthough NIPT has the merits of greater effectiveness and safety, CMSS is unlikely to be replaced by NIPT at this time because of NIPT's higher cost. Contingent screening may be an appropriate strategy to balance the effectiveness and cost factors of the new genetic testing technology.

VP36 Cost-Effectiveness Of Non-Invasive Prenatal Testing For Down Syndrome

2017 ◽  
Vol 33 (S1) ◽  
pp. 165-166
Author(s):  
Estibalitz Orruño ◽  
Juan Carlos Bayón ◽  
Isabel Portillo ◽  
José Asua
Keyword(s):  
Down Syndrome ◽  
Cost Effectiveness ◽  
Prenatal Screening ◽  
Prenatal Testing ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Non Invasive ◽  
Cell Free Fetal Dna ◽  
Primary Test ◽  
The Cost

INTRODUCTION:The analysis of cell-free fetal DNA in maternal blood, also called Non-Invasive Prenatal Testing (NIPT), represents an emerging technology and a possible alternative/complement to current prenatal screening based on biochemical and sonographic markers for Down Syndrome (DS) detection.The aim of the study was to compare the application of NIPT with the prenatal diagnosis/screening procedures currently applied in the Basque Country.METHODS:An analytical decision model was developed to assess the costs and consequences, comparing current prenatal screening, NIPT as a contingency test in high-risk cases and NIPT as a first-line screening test. An economic analysis was conducted to determine which strategy was more cost-effective. Sensitivity analyses were performed (1).RESULTS:For a population of 97,074 pregnant women in gestational week 14 and a cut-off point of 1:270, NIPT as a contingent test was not cost-effective, detecting two cases less of DS and causing a lower number of miscarriages related to invasive-testing (4 versus 23) at a slightly lower cost (EUR8,111,351 versus EUR8,901,872).For risk cut-off points of 1:500 or 1:1000 for contingent NIPT, the number of DS cases detected increased, as did the cost. It could be cost-effective compared with current prenatal screening, (EUR61,763 or EUR256,123 per extra DS case detected, respectively).Using the NIPT as a primary test detected more DS cases (296 versus 271) and caused less miscarriages (5 versus 23), at a substantially higher cost (EUR41,395,645 versus EUR8,901,872). Cost-effectiveness analysis indicated that it was more expensive and more effective.Univariant sensitivity-analysis showed that when the price of the NIPT as primary test was EUR76, it was dominant compared with current prenatal screening. It was also cost-effective compared with the NIPT as a contingent test (EUR9,869 per extra DS case detected).CONCLUSIONS:The study shows that NIPT had higher detection rates for DS in different scenarios, but the cost constitutes a limiting factor for implementation in the Basque Health System.

scholarly journals Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038505
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Farah Seedat ◽  
John Marshall ◽  
Heather Bailey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pregnant Women ◽  
Neonatal Death ◽  
Cost Effective ◽  
Screening Strategy ◽  
Base Case ◽  
Scenario Analyses ◽  
The Uk ◽  
The Cost ◽  
In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

scholarly journals Do non-invasive prenatal tests promote discrimination against people with Down syndrome? What should be done?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Klaus Zerres ◽  
Sabine Rudnik-Schöneborn ◽  
Wolfgang Holzgreve
Keyword(s):  
Down Syndrome ◽  
Pregnant Women ◽  
Maternity Care ◽  
Trisomy 21 ◽  
Genetic Diagnosis ◽  
Prenatal Testing ◽  
Reproductive Autonomy ◽  
Personal View ◽  
Non Invasive ◽  
Ethical Debate

Abstract By implementation of non-invasive prenatal testing (NIPT) for the diagnosis of Down syndrome (DS) in maternity care, an ethical debate is newly inflamed how to deal with this information. Fears of the consequences of an increased use of NIPT are justified with the same arguments when amniocentesis and preimplantation genetic diagnosis (PGD) were introduced decades ago. It can be expected that the prevalence of people with DS would significantly increase in Western societies as a result of the increasing age of pregnant women and the improved medical care for people with DS. The net effect as to whether an increasing uptake of NIPT will result in more abortions of fetuses with trisomy 21 cannot be reliably estimated. This holds true since more and more couples will use results of NIPT for information only, but will not opt for termination of pregnancy. Although parents love their children with DS, in a society where reproductive autonomy is seen as an achievement, access to NIPT cannot be limited. On this background, comprehensive and qualified pretest counseling is vital, also to avoid possible stigmatization of people with DS and as the resulting consequence to avoid feared deterioration in their living conditions, for which, however, there is no evidence to date. The personal view of a mother of a child with DS illustrates the complexity in dealing with NIPT, which does not allow simple answers and must be understood as a challenge for society as a whole.

Cost-Effectiveness of Universal Hepatitis B Virus Screening in Patients Beginning Chemotherapy for Solid Tumors

2011 ◽  
Vol 29 (24) ◽  
pp. 3270-3277 ◽  
Author(s):  
Fiona L. Day ◽  
Jonathan Karnon ◽  
Danny Rischin
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Universal Screening ◽  
Cost Effective ◽  
Screening Strategy ◽  
Sensitivity Analyses ◽  
B Virus ◽  
The Cost ◽  
Hbv Screening

PurposeUniversal screening for chronic hepatitis B virus (HBV) infection before chemotherapy has been recommended. We evaluated the cost-effectiveness of HBV screening before chemotherapy given for nonhematopoietic solid tumors (STs).MethodsA decision-analytic model was used to compare the cost-effectiveness of universal screening conducted per professional guidelines versus no screening in hypothetical patient cohorts beginning adjuvant chemotherapy for early breast cancer or palliative chemotherapy for advanced non–small-cell lung cancer. Survival times were extrapolated using Markov models. Probabilities were derived from published studies and costs estimated from the perspective of the Australian health care system. One-way and probabilistic sensitivity analyses were performed, including with the application of an alternative HBV screening strategy.ResultsUsing an incremental cost-effectiveness ratio threshold of $50,000 (Australian dollars) per life-year (LY) saved, universal HBV screening was not cost-effective for adjuvant patients ($88,224/LY, 13% probability of being cost-effective), palliative patients ($1,344,251/LY, 0%), or pooled (all) patients ($149,857/LY, 1%). Sensitivity analyses found that screening approached cost-effectiveness among adjuvant patients with the highest reported rates of undiagnosed chronic HBV (65%, $59,445/LY) or HBV reactivation with chemotherapy (41%, $56,537/LY). Cost- effectiveness was also significantly influenced by HBV population prevalence. An alternative screening strategy using hepatitis B surface antigen testing only produced the most economically favorable results, with $30,126/LY (80% probability) for adjuvant patients and $51,201/LY (43%) for the pooled cohort.ConclusionUniversal HBV screening conducted per current guidelines is not cost-effective in patients with STs. Screening may be economically favorable in selected patient subpopulations and/or with simplification of the screening strategy.

A Cost-Effectiveness Analysis of Pediatric Intraosseous Infusion as a Prehospital Skill

1992 ◽  
Vol 7 (3) ◽  
pp. 221-227 ◽  
Author(s):  
Herbert G. Garrison ◽  
Stephen M. Downs ◽  
Robert A. McNutt ◽  
Thomas R. Griggs
Keyword(s):  
Cost Effectiveness ◽  
Clinical Efficacy ◽  
Vascular Access ◽  
Cost Effective ◽  
Epidemiologic Studies ◽  
Decision Analytic Model ◽  
Cost Effectiveness Ratio ◽  
Number Of Patients ◽  
Program Costs ◽  
The Cost

AbstractPurpose:To determine the clinical efficacy, patient volume, and program costs that justify pediatric intraosseous (IO) infusion as a routine skill for the treatment of patients with cardiac arrest in a prehospital system.Methods:A decision analytic model was constructed to include patient outcomes and costs to society. Critical variables for the analysis were: 1) time to vascular access; 2) success of vascular access; 3) clinical efficacy (i.e., the percentage of lives saved by early vascular access); 4) number of patients requiring IO annually; and 5) the cost of an IO program. Program costs included training and equipment expenses. Sensitivity analysis, which repeatedly evaluates the model using different values for the critical variables, identified those values at which IO would be cost-effective.Results:With an estimated 80% success rate for IO access within five minutes, the cost-per-life-saved would be [US] $161,000. This cost-effectiveness ratio assumed annual program expenses of $2,000 and one patient per year needing IO. The cost-effectiveness ratio also required a clinical efficacy of 2% for vascular access. To prove that the clinical efficacy of vascular access is in fact 2%, epidemiologic studies would require a sample of nearly 9,000 patients.Conclusions:This analysis suggests IO probably is cost-effective given a clinical efficacy above 2%. While the true efficacy may be below this value, clinical studies are unlikely to have sufficient size to prove it. Therefore, emergency medical services (EMS) medical directors must make the decision to utilize IO based on their own beliefs about its clinical efficacy. Further, it must be considered in the context of other prehospital programs which may be more cost-effective. Such analyses permit establishment of rational priorities to rank programs in prehospital systems.

scholarly journals The role of information provision in economic evaluations of non-invasive prenatal testing: a systematic review

2019 ◽  
Vol 20 (8) ◽  
pp. 1123-1131
Author(s):  
Nikita M. John ◽  
Stuart J. Wright ◽  
Sean P. Gavan ◽  
Caroline M. Vass
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Economic Evaluation ◽  
Prenatal Testing ◽  
Information Provision ◽  
Economic Evaluations ◽  
Non Invasive ◽  
The Cost ◽  
The Impact

Abstract Background Technological progress has led to changes in the antenatal screening programmes, most significantly the introduction of non-invasive prenatal testing (NIPT). The availability of a new type of testing changes the type of information that the parent(s) require before, during and after screening to mitigate anxiety about the testing process and results. Objectives To identify the extent to which economic evaluations of NIPT have accounted for the need to provide information alongside testing and the associated costs and health outcomes of information provision. Methods A systematic review of economic evaluations of NIPTs (up to February 2018) was conducted. Medline, Embase, CINAHL and PsychINFO were searched using an electronic search strategy combining a published economic search filter (from NHS economic evaluations database) with terms related to NIPT and screening-related technologies. Data were extracted using the Consolidated Health Economic Evaluation Reporting Standards framework and the results were summarised as part of a narrative synthesis. Results A total of 12 economic evaluations were identified. The majority of evaluations (n = 10; 83.3%) involved cost effectiveness analysis. Only four studies (33.3%) included the cost of providing information about NIPT in their economic evaluation. Two studies considered the impact of test results on parents’ quality of life by allowing utility decrements for different outcomes. Some studies suggested that the challenges of valuing information prohibited their inclusion in an economic evaluation. Conclusion Economic evaluations of NIPTs need to account for the costs and outcomes associated with information provision, otherwise estimates of cost effectiveness may prove inaccurate.

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