title: A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States.
abstract: BACKGROUND
  Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS.
  
  
  METHODS
  Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer.
  
  
  RESULTS
  From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective.
  
  
  CONCLUSIONS
  From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS.
authors.affiliation: ARUP Laboratories, Salt Lake City, Utah, United States of America.
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Walker
authors.affiliation: Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: Department of Pathology and ARUP Laboratories, Salt Lake City, Utah, United States of America.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jackson
authors.affiliation: Department of Pathology and ARUP Laboratories, Salt Lake City, Utah, United States of America.
authors.forename: David G
authors.initials: DG
authors.lastname: Grenache
authors.affiliation: Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Ashwood
authors.affiliation: Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Schmidt
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis / Q000191:economics*; D014314:Trisomy / Q000175:diagnosis*; D014481:United States