Table 26:
Sensitivity Analysis Results, Prenatal Screening Strategies
| Variable | Strategy | Total Costs (95% CrI), $ | Cases Detected (95% CrI), n | Diagnostic Tests Performed (95% CrI), n | Incremental Cost Per Case Detected, First-Tier vs. Second-Tier NIPT, $ |
|---|---|---|---|---|---|
| NIPT Price | |||||
| $200 | Second-tier NIPT | 26,084,204 (22,798,602–29,280,686) | NAa | NAa | — |
| First-tier NIPT | 42,750,076 (38,190,790–47,735,425) | NAa | NAa | 198,236 | |
| $300 | Second-tier NIPT | 26,412,508 (22,909,454–29,548,072) | NAa | NAa | — |
| First-tier NIPT | 52,333,813 (45,555,192–58,487,874) | NAa | NAa | 309,106 | |
| $500 | Second-tier NIPT | 27,119,609 (23,728,181–30,263,419) | NAa | NAa | — |
| First-tier NIPT | 72,141,215 (62,179,210–82,628,259) | NAa | NAa | 535,404 | |
| $600 | Second-tier NIPT | 27,460,478 (24,118,240–30,805,287) | NAa | NAa | — |
| First-tier NIPT | 81,849,048 (70,303,593–93,705,152) | NAa | NAa | 647,421 | |
| NIPT False-Positive Rate | |||||
| 0.1% | Second-tier NIPT | 26,654,498 (23,246,365–29,967,176) | NAa | 659 (582–746) | — |
| First-tier NIPT | 59,789,622 (51,478,080–68,306,686) | NAa | 571 (444–699) | 394,997 | |
| 0.5% | Second-tier NIPT | 26,715,288 (23,418,883–29,980,976) | NAa | 672 (599–757) | — |
| First-tier NIPT | 59,991,375 (51,792,152–68,305,006) | NAa | 901 (766–1,036) | 396,309 | |
| 1% | Second-tier NIPT | 26,725,446 (23,407,759–29,910,452) | NAa | 687 (608–773) | — |
| First-tier NIPT | 60,395,928 (52,277,838–68,913,184) | NAa | 1,308 (1,178–1,445) | 403,157 | |
| Trisomy Prevalence | |||||
| 10% lower prevalence of trisomies 21, 18 and 13 than the reference case | Second-tier NIPT | 26,637,545 (23,471,426–30,144,412) | 169 (130–211) | 702 (623–796) | — |
| First-tier NIPT | 61,228,599 (53,246,695–69,691,743) | 245 (194–301) | 2,108 (1,821–2,406) | 456,702 | |
| 20% higher prevalence of trisomies 21, 18, and 13 than the reference case | Second-tier NIPT | 26,757,004 (23,432,884–29,950,239) | 225 (179–282) | 754 (671–857) | — |
| First-tier NIPT | 61,468,969 (53,499,592–69,764,090) | 326 (260–399) | 2,177 (1,900–2,492) | 342,973 | |
| Acceptance Rate for Further Testing | |||||
| After positive NIPT results, first-tier NIPT: 90% | First-tier NIPT | 61,461,986 (53,728,139–69,621,998) | 288 (232–358) | 2,242 (1,936–2,554) | 347,947b |
| After positive NIPT results, first-tier NIPT: 95% | First-tier NIPT | 61,526,572 (53,679,534–69,414,722) | 305 (244–374) | 2,368 (2,049–2,719) | 299,771b |
| After positive results from traditional prenatal screening, second-tier NIPT: 85% | Second-tier NIPT | 26,910,157 (23,520,315–30,207,872) | 210 (166–267) | 804 (711–916) | 546,804c |
| After positive results from traditional prenatal screening, second-tier NIPT: 95% | Second-tier NIPT | 27,163,740 (23,753,183–30,751,347) | 234 (188–298) | 898 (800–1,008) | 891,252c |
| NIPT Failure Rate | |||||
| 4%d | Second-tier NIPT | 26,774,569 (23,364,183–30,097,831) | 188 (147–236) | 783 (687–880) | — |
| First-tier NIPT | 61,567,714 (53,390,895–70,139,842) | 270 (216–330) | 2,310 (2,046–2,588) | 426,967 | |
| Cost of Post-Test Physician Visits for Pregnant People With Positive Screening Results for All Strategies | |||||
| $33.7 | Second-tier NIPT | 26,475,773 (23,201,201–29,875,843) | NAa | NAa | — |
| First-tier NIPT | 61,197,204 (52,937,184–69,348,009) | NAa | NAa | 413,414 | |
Abbreviations: CrI, credible interval, NIPT, noninvasive prenatal testing.
Note: Numbers may appear inexact due to rounding.
a
This analysis did not affect the results of this outcome, which was same as that reported in Table 18 (reference case).
b
The cost and effectiveness of second-tier NIPT was based on the reference case results.
c
The cost and effectiveness of first-tier NIPT was based on the reference case results.
d
There was no additional cost for a repeat NIPT test.