Contingent non‐invasive prenatal testing: an opportunity to improve non‐genetic aspects of fetal aneuploidy screening. (27th October 2015)

• Record Type: Journal Article
• Authors: Gyselaers, Wilfried; Hulstaert, Frank; Neyt, Mattias
• Is Part Of: Prenatal diagnosis. Volume 35:Number 13(2015:Dec.)
• Page Start: 1347
• Page End: 1352
• Publication Date: 2015-10-27
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4704
• Languages: English
• ISSNs: 0197-3851

Abstract

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. Conclusion: 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. © 2015 John Wiley & Sons, Ltd. Abstract : What's already known about this topic? NIPT is the best possible screening method for fetal Down syndrome today, but the cost per test currently is too high for a swift introduction as a universal screening test without increasing the national screening budget. After introduction of full NIPT screening, ultrasound screening still remains useful to detect structural anomalies and should be maintained in addition to NIPT. Apart from Belgium, there are other countries where suboptimal fetal aneuploidy screening is in place today, and where quality improvement of non‐genetic aspects of screening is desirable. What does this study add? Even when the introduction of full NIPT screening is considered, the economic savings from a (temporary) contingent NIPT protocol may be used to install measures for improvement of those aspects of fetal aneuploidy screening which will run in parallel to NIPT, such as stimulating sonographer's intentions to participate in audit and quality control, enhancing access to high quality ultrasound screening service and centralizing prenatal invasive procedures.