title: Contingent non-invasive prenatal testing: an opportunity to improve non-genetic aspects of fetal aneuploidy screening.
abstract: BACKGROUND
  Several countries today struggle with suboptimal performances in many aspects of the fetal aneuploidy screening process and consider introducing non-invasive prenatal screening (NIPT) as a solution. In this study, costs and benefits of different scenarios for contingent NIPT screening in Belgium are evaluated with respect to partial redistribution of the national screening budget into quality improving measures for those screening activities that will be maintained when full NIPT screening is implemented.
  
  
  METHODS
  Data from the Belgian National Institute for Health and Disability Insurance and the Study Centre for Perinatal Epidemiology were used in modeled calculations of medical and economic impact of NIPT after prior conventional screening (1) at thresholds 1:300 and 1:600, and (2) at current and improved screening sensitivity.
  
  
  RESULTS
  Contingent NIPT screening under current screening conditions would maintain today's 7.9(0)/000 live birth prevalence of Down syndrome (LBPD) at an 11% reduction of overall short-term costs. Lowering the screening threshold to 1:600 or increasing sensitivity by 10% would reduce LBPD to 7(0)/000 at a maximum 3% increase of overall short-term costs.
  
  
  CONCLUSIONS
  Today, in Belgium and in many other countries, full NIPT screening is considered too expensive for immediate introduction into the national fetal aneuploidy screening program. Contingent NIPT screening is both clinically and economically beneficial. A temporary contingent NIPT protocol allows for reinvesting economic savings into optimization of those screening aspects, which are to be maintained in parallel to full NIPT screening.
authors.affiliation: Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.|Department of Physiology, Hasselt University, Hasselt, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Gyselaers
authors.affiliation: Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Hulstaert
authors.affiliation: Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
authors.forename: Mattias
authors.initials: M
authors.lastname: Neyt
mesh_terms: D000782:Aneuploidy; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*