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. 2019 Feb 19;19(4):1–166.

Table 10:

Calculated Approximate Cost and Effectiveness Per 10,000 Pregnant People From Included Studies

    Approximated Cost and Effectiveness per 10,000 Pregnant People
Name, Year, Location Intervention/Comparator Health Outcomes Costs ICER (Incremental Cost Per Additional Case Identified)
Nshimyumukiza et al, 2018,74 Canada

  • FTS (risk cutoff 1:300 for trisomy 21)

  • MSS (risk cutoff 1:300 for trisomy 21)

  • FTS + NIPT

  • MSS + NIPT

  • Universal NIPT

 Total trisomy 21, 18, and 13 cases identified, n:

  • FTS: 24.9

  • MSS: 21.3

  • FTS + NIPT: 22.3

  • MSS + NIPT: 18.6

  • Universal NIPT: 27.8


Diagnostic tests, n:

  • FTS: 235.7

  • MSS: 278.9

  • FTS + NIPT: 25.9

  • MSS + NIPT: 22.4

  • Universal NIPT: 47.8

 CAD; fiscal year 2014/15
Cost of NIPT: $795 per test

  • FTS: $1.5 M

  • MSS: $1.1 M

  • FTS + NIPT: $1.3 M

  • MSS + NIPT: $0.9 M

  • Universal NIPT: $5.9 M

 Second-tier NIPT vs. traditional prenatal screening:

  • FTS + NIPT vs. FTS: FTS + NIPT was less effective and less costly, so we did not calculate an ICERb

  • MSS + NIPT vs. MSS: MSS + NIPT was less effective and less costly, so we did not calculate an ICERb


First-tier vs. second-tier NIPT:

  • Universal NIPT vs. FTS + NIPT: $819,048

  • Universal NIPT vs. MSS + NIPT: $540,385
Huang et al, 2017,75 Canada

  • IPS (risk cutoff 1:200)

  • FTS (risk cutoff 1:1,500) + NIPT

  • eFTS (risk cutoff 1:1,000) + NIPT

  • Universal NIPT(a): 100% of those with NIPT test failures would have diaqnostic testinq

  • Universal NIPT(b): 0% of those with NIPT test failures would have diagnostic testing

 Trisomy 21 cases identified, n:

  • IPS: 13.9

  • FTS + NIPT: 24.4

  • eFTS + NIPT: 24.4

  • Universal NIPT(a): 25.8

  • Universal NIPT(b): 25.0


Diagnostic tests, n:

  • IPS: 327.6

  • FTS + NIPT: 83.5

  • eFTS + NIPT: 57.8

  • Universal NIPT(a): 334.7

  • Universal NIPT(b): 34.7

 CAD; costing year not reported
Cost of NIPT: $400 per test

  • IPS: $1.8 M

  • FTS + NIPT: $2.0 M

  • eFTS + NIPT: $1.7 M

  • Universal NIPT(a): $4.6 M

  • Universal NIPT(b): $4.1 M

 Second-tier NIPT vs. traditional prenatal screening:

  • FTS + NIPT vs. IPS: $16,505

  • eFTS + NIPT vs. IPS: dominant


First-tier vs. second-tier NIPT:

  • Universal NIPT(b) vs. FTS + NIPT: $4.12 M

  • Universal NIPT(b) vs. eFTS + NIPT: $4.52 M
Maxwell et al, 2017,76 Australia

  • FTS (risk cutoff 1:300)

  • FTS + NIPT (risk cutoff 1:300 for NIPT and 1:5 for diagnostic testing)

  • FTS + NIPT (risk cutoff 1:1,000 for NIPT and 1:10 for diagnostic testing)

 Trisomy 21 cases identified, na:

  • NA


Diagnostic testsa:

  • NA

 Australian dollars; 2014
Cost of NIPT: $400 per test

  • FTS: $1.3 M

  • FTS + NIPT (risk cutoff 1:300): $1.2 M

  • FTS + NIPT (risk cutoff 1:1,000): $1.4 M

 NA
Colosi et al, 2017,77 Italy

  • FTS (risk cutoff 1:250)

  • FTS + NIPT and without nasal bone evaluation

  • FTS + NIPT and with nasal bone evaluation

  • Universal NIPT

 Trisomy 21 cases identified, na:

  • NA


Diagnostic tests, n:

  • FTS: 630.3

  • FTS + NIPT without nasal bone evaluation: 162.7

  • FTS + NIPT with nasal bone evaluation: 136.8

  • Universal NIPT: 364.8 (both positive NIPT results and NIPT test failures received diagnostic testing)

 Euros; cost year not reported
Cost of NIPT: €260 per test

  • FTS: €1.2 M

  • FTS + NIPT without nasal bone evaluation: €1.3 M

  • FTS + NIPT with nasal bone evaluation: €1.1 M

  • Universal NIPT: €2.8 M

 NA
Chitty et al, 2016,78 United Kingdom

  • Traditional prenatal screening: FTS (86.9%) and MSS (13.1%)

  • FTS/MSS + NIPT(a): people can have diagnostic testing directly without NIPT first (risk cutoff 1:150)

  • FTS/MSS + NIPT(b): people cannot have diagnostic testing directly (risk cutoff, 1:150)

 Trisomy 21 cases identified, n:

  • FTS/MSS: 8.3

  • FTS/MSS + NIPT(a): 9.8

  • FTS/MSS + NIPT(b): 8.0


Diagnostic tests, n:

  • FTS/MSS: 82.2

  • FTS/MSS + NIPT(a): 34

  • FTS/MSS + NIPT(b): 8.8

 GBP; 2012/13
Cost of NIPT: £250 per test

  • FTS/MSS: $0.24 M

  • FTS/MSS + NIPT(a): $0.24 M

  • FTS/MSS + NIPT(b): $0.23 M

 Second-tier NIPT

  • FTS/MSS + NIPT(a) vs. FTS/MSS: FTS/MSS + NIPT(a) dominated FTS/MSS with greater effectiveness and equal cost

  • FTS/MSS + NIPT(b) vs. FTS/MSS: FTS/MSS + NIPT(b) was less effective and less costly, so we did not calculate an ICERb
Fairbrother et al 2016,79 United States

  • FTS

  • Universal NIPT

 Trisomy 21, 18, and 13 cases identified, n:

  • FTS: 19.5

  • Universal NIPT: 22.5


Diagnostic tests, n:

  • FTS: 368.3

  • Universal NIPT: 43.3

 USD; 2014
No explicit cost for NIPT in analysis

  • FTS: $9.7 M

  • Universal NIPTa: When the NIPT unit cost was $453 or less, NIPT resulted in cost savings comDared with FTS

 NA

Abbreviations: eFTS, enhanced first-trimester screening; FTS, first-trimester screening; ICER, incremental cost-effectiveness ratio (incremental cost per additional case detected); IPS, integrated prenatal screening; MSS, maternal serum screening (also known as quadruple screening); M, million; NA, not applicable; NIPT, noninvasive prenatal testing.

Note: These calculated results are based on the reported study data and have not been verified by study authors; the findings should be interpreted with caution.

a

It was not straightforward to obtain an accurate estimate of these parameters, so we did not calculate this value.

b

When both the incremental cost and incremental effectiveness have negative values, there is a positive ICER. However, its interpretation is opposite from a positive ICER because of a positive incremental cost and incremental effectiveness. To avoid confusion, we did not present these calculated ICERs.