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Léon Nshimyumukiza Jean-Alexandre Beaumont Julie Duplantie Sylvie Langlois Julian Little François Audibert Christopher McCabe Jean Gekas Yves Giguère Christian Gagné Daniel Reinharz François Rousseau 《Journal d'obstetrique et gynecologie du Canada》2018,40(1):48-60
Objective
Yearly, 450?000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness of NIPT strategies compared with conventional strategies.Methods
This study used a decision analytic model to estimate the cost-effectiveness of 13 prenatal screening strategies for fetal aneuploidies: six frequently used strategies, universal NIPT, and six strategies incorporating NIPT as a second-tier test. The study considered a virtual cohort of pregnant women of similar size and age as women in Quebec. Model data were obtained from published sources and government databases. The study predicted the number of chromosomal anomalies detected (trisomies 21, 13, and 18), invasive procedures and euploid fetal losses, direct costs, and incremental cost-effectiveness ratios.Results
Of the 13 strategies compared, eight identified fewer cases at a higher cost than at least one of the remaining five strategies. Integrated serum screening with conditional NIPT had the lowest cost, and the cost per case detected was $63?139, with a 90% reduction of invasive procedures. The number of cases identified was improved with four other screening strategies, but with increasing of incremental costs per case (from $61?623 to $1?553?615). Results remained robust, except when NIPT costs and risk cut-offs varied.Conclusion
NIPT as a second-tier test for high-risk women is likely to be cost-effective as compared with screening algorithms not involving NIPT. 相似文献8.
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Michelle F. Mottola Margie H. Davenport Stephanie-May Ruchat Gregory A. Davies Veronica Poitras Casey Gray Alejandra Jaramillo Nick Barrowman Kristi B. Adamo Mary Duggan Ruben Barakat Phil Chilibeck Karen Fleming Milena Forte Jillian Korolnek Taniya Nagpal Linda Slater Deanna Stirling Lori Zehr 《Journal d'obstetrique et gynecologie du Canada》2018,40(11):1528-1537