title: A cost-effectiveness analysis comparing different strategies to implement noninvasive prenatal testing into a Down syndrome screening program.
abstract: BACKGROUND
  Currently, noninvasive prenatal testing (NIPT) is only recommended in high-risk women following conventional Down syndrome (DS) screening, and it has not yet been included in the Australian DS screening program.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of different strategies of NIPT for DS screening in comparison with current practice.
  
  
  METHODS
  A decision-analytic approach modelled a theoretical cohort of 300,000 singleton pregnancies. The strategies compared were the following: current practice, NIPT as a second-tier investigation, NIPT only in women >35 years, NIPT only in women >40 years and NIPT for all women. The direct costs (low and high estimates) were derived using both health system costs and patient out-of-pocket expenses. The number of DS cases detected and procedure-related losses (PRL) were compared between strategies. The incremental cost per case detected was the primary measure of cost-effectiveness.
  
  
  RESULTS
  Universal NIPT costs an additional $134,636,832 compared with current practice, but detects 123 more DS cases (at an incremental cost of $1,094,608 per case) and avoids 90 PRL. NIPT for women >40 years was the most cost-effective strategy, costing an incremental $81,199 per additional DS case detected and avoiding 95 PRL.
  
  
  CONCLUSIONS
  The cost of NIPT needs to decrease significantly if it is to replace current practice on a purely cost-effectiveness basis. However, it may be beneficial to use NIPT as first-line screening in selected high-risk patients. Further evaluation is needed to consider the longer-term costs and benefits of screening.
authors.affiliation: School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Ayres
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Whitty
authors.forename: David A
authors.initials: DA
authors.lastname: Ellwood
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis / Q000191:economics*
keywords: benefits; consequences; cost; implementation; noninvasive prenatal testing