Non-invasive prenatal testing for detection of Down syndrome in
Government-funded projects: a cost-effectiveness analysis based on
real-world data from China
Abstract
Abstract: Objective: This study aimed to assess the cost-effectiveness
of implementing NIPT screening for DS based on government-funded
projects in China. Design: Decision analytical model. Setting: Fuyang
City People’s Hospital (FCPH) in China. Population: 1,400 maternal women
in FCPH for the period March to June 2019. Methods: An incremental
cost-effectiveness ratio (ICER) was calculated from a societal
perspective. Univariate sensitivity analysis measured the impact of the
uptake rate of NIPT and the cost of NIPT, and probabilistic sensitivity
analysis (PSA) also was conducted. Main outcome measures:The number of
DS case detected. Results: NIPT age-related screening strategy (Strategy
D) has the lowest ICER, with an ICER of USD 25,641.22 per additional DS
case detected compared with second-trimester serum screening Strategy
(Strategy A). Universal NIPT screening (Strategy E) was the most
effective and showed more DS case detected compared with alternative
strategies. However, it was also the most expensive strategy. Strategy E
would not be cost-effective unless the unit cost of NIPT could be
decreased to USD 57.00. PSA results indicated that, at
willingness-to-pay threshold under USD 120,000.00, Strategy D is
cost-effective compared with combined serum and NIPT screening (Strategy
C, also the referred strategy in China). Conclusion: Compared with
current referred screening strategy in China, age-related NIPT
contingent screening performances better in cost-effectiveness analysis
and safety, which should be recommended to pregnant women. While under
the government-funded projects in China, universal NIPT screening is
still not optimal. Lowering the price of NIPT is an effective measure to
promote universal NIPT Strategy