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

Published online by Cambridge University Press:  27 May 2019

Yan Xu
Affiliation:
Key Lab of Health Technology Assessment, National Health Commission (Fudan University), School of Public Health, Fudan University, Shanghai, China
Yan Wei
Affiliation:
Key Lab of Health Technology Assessment, National Health Commission (Fudan University), School of Public Health, Fudan University, Shanghai, China
Jian Ming
Affiliation:
Key Lab of Health Technology Assessment, National Health Commission (Fudan University), School of Public Health, Fudan University, Shanghai, China
Na Li
Affiliation:
Key Lab of Health Technology Assessment, National Health Commission (Fudan University), School of Public Health, Fudan University, Shanghai, China
Ningze Xu
Affiliation:
Key Lab of Health Technology Assessment, National Health Commission (Fudan University), School of Public Health, Fudan University, Shanghai, China
Raymond W. Pong
Affiliation:
Centre for Rural and Northern Health Research, Laurentian University, Canada
Yingyao Chen*
Affiliation:
Key Lab of Health Technology Assessment, National Health Commission (Fudan University), School of Public Health, Fudan University, Shanghai, China
*
Author for correspondence: Yingyao Chen, E-mail: yychen@shmu.edu.cn

Abstract

Objectives

There 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.

Methods

To 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.

Results

The 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.

Conclusions

Although 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.

Type
Assessment
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

This study was funded by the National Health and Family Planning Commission of China and the China Medical Board Health Technology Assessment Collaborating Program in China(13-153 and 16-251). The main part of this article was presented orally at the Health Technology Assessment International (HTAi) annual meeting in 2017. We also appreciate the anonymous reviewers’ helpful comments and suggestions for improvement.

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