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    Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing

    Access Status
    Fulltext not available
    Authors
    Maxwell, S.
    O'Leary, Peter
    Dickinson, J.
    Suthers, G.
    Date
    2017
    Type
    Journal Article
    
    Metadata
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    Citation
    Maxwell, S. and O'Leary, P. and Dickinson, J. and Suthers, G. 2017. Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing. The Australian and New Zealand Journal of Obstetrics and Gynaecology. 57 (4): pp. 432-439.
    Source Title
    The Australian and New Zealand Journal of Obstetrics and Gynaecology
    DOI
    10.1111/ajo.12612
    ISSN
    0004-8666
    Faculty
    Faculty of Health Sciences
    URI
    http://hdl.handle.net/20.500.11937/57656
    Collection
    • Curtin Research Publications
    Abstract

    © 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.

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      Maxwell, Susannah; James, I.; Dickinson, J.; O'Leary, Peter (2016)
      © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Objective: To provide data on how screen-positive and detection rates of first trimester prenatal screening for fetal Down syndrome ...
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