Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing
© 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Contingent screening for trisomy 21 using non-invasive prenatal testing has the potential to reduce invasive diagnostic testing and increase the detection of trisomy 21. Aim: To describe the diagnosti...
| Main Authors: | , , , |
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| Format: | Journal Article |
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Blackwell Publishing
2017
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| Online Access: | http://hdl.handle.net/20.500.11937/57656 |
| _version_ | 1848760188050341888 |
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| author | Maxwell, S. O'Leary, Peter Dickinson, J. Suthers, G. |
| author_facet | Maxwell, S. O'Leary, Peter Dickinson, J. Suthers, G. |
| author_sort | Maxwell, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Contingent screening for trisomy 21 using non-invasive prenatal testing has the potential to reduce invasive diagnostic testing and increase the detection of trisomy 21. Aim: To describe the diagnostic and economic performance of prenatal screening models for trisomy 21 that use non-invasive prenatal testing as a contingent screen across a range of combined first trimester screening risk cut-offs from a public health system perspective. Methods: Using a hypothetical cohort of 300 000 pregnancies, we modelled the outcomes of 25 contingent non-invasive prenatal testing screening models and compared these to conventional screening, offering women with a high-risk (1 > 300) combined first trimester screening result an invasive test. The 25 models used a range of risk cut-offs. High-risk women were offered invasive testing. Intermediate-risk women were offered non-invasive prenatal testing. We report the cost of each model, detection rate, costs per diagnosis, invasive tests per diagnosis and the number of fetal losses per diagnosis. Results: The cost per prenatal diagnosis of trisomy 21 using the conventional model was $51 876 compared to the contingent models which varied from $49 309–66 686. The number of diagnoses and cost per diagnosis increased as the intermediate-risk threshold was lowered. Results were sensitive to trisomy 21 incidence, uptake of testing and cost of non-invasive prenatal testing. Conclusion: Contingent non-invasive prenatal testing models using more sensitive combined first trimester screening risk cut-offs than conventional screening improved the detection rate of trisomy 21, reduced procedure-related fetal loss and could potentially be provided at a lower cost per diagnosis than conventional screening. |
| first_indexed | 2025-11-14T10:11:48Z |
| format | Journal Article |
| id | curtin-20.500.11937-57656 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:11:48Z |
| publishDate | 2017 |
| publisher | Blackwell Publishing |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-576562017-11-24T05:46:18Z Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing Maxwell, S. O'Leary, Peter Dickinson, J. Suthers, G. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Contingent screening for trisomy 21 using non-invasive prenatal testing has the potential to reduce invasive diagnostic testing and increase the detection of trisomy 21. Aim: To describe the diagnostic and economic performance of prenatal screening models for trisomy 21 that use non-invasive prenatal testing as a contingent screen across a range of combined first trimester screening risk cut-offs from a public health system perspective. Methods: Using a hypothetical cohort of 300 000 pregnancies, we modelled the outcomes of 25 contingent non-invasive prenatal testing screening models and compared these to conventional screening, offering women with a high-risk (1 > 300) combined first trimester screening result an invasive test. The 25 models used a range of risk cut-offs. High-risk women were offered invasive testing. Intermediate-risk women were offered non-invasive prenatal testing. We report the cost of each model, detection rate, costs per diagnosis, invasive tests per diagnosis and the number of fetal losses per diagnosis. Results: The cost per prenatal diagnosis of trisomy 21 using the conventional model was $51 876 compared to the contingent models which varied from $49 309–66 686. The number of diagnoses and cost per diagnosis increased as the intermediate-risk threshold was lowered. Results were sensitive to trisomy 21 incidence, uptake of testing and cost of non-invasive prenatal testing. Conclusion: Contingent non-invasive prenatal testing models using more sensitive combined first trimester screening risk cut-offs than conventional screening improved the detection rate of trisomy 21, reduced procedure-related fetal loss and could potentially be provided at a lower cost per diagnosis than conventional screening. 2017 Journal Article http://hdl.handle.net/20.500.11937/57656 10.1111/ajo.12612 Blackwell Publishing restricted |
| spellingShingle | Maxwell, S. O'Leary, Peter Dickinson, J. Suthers, G. Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| title | Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| title_full | Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| title_fullStr | Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| title_full_unstemmed | Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| title_short | Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| title_sort | diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing |
| url | http://hdl.handle.net/20.500.11937/57656 |