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UOG Journal Club: November 201 9

UOG Journal Club: November 201 9. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities : model-based analysis.

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UOG Journal Club: November 201 9

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  1. UOG Journal Club: November 2019 Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis LE BRAS, L. J. SALOMON, L. BUSSIÈRES, V. MALAN, C. ELIE, H. MAHALLATI,Y. VILLE, M. VEKEMANS and I. DURAND-ZALESKI Volume 54, Issue 5, pages 596–603 Journal Club slides prepared by Dr ErkanKalafat (UOG Editor for Trainees)

  2. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 INTRODUCTION • Cell-free DNA testing (cfDNA)-based trisomy screening is recommended for all women with a risk for T21 between 1/51 and 1/1000 according to first-trimester combined screening (FTS) in France. • Economical advantages of cfDNA testing in this setting over invasive testing are not established. • In the recent SAFE21 trial, women with a risk between 1/5 and 1/250 were randomized to either invasive testing or cfDNA and invasive testing (in case of positive cfDNA). There was no significant difference in miscarriage rates between the two groups, while the invasive testing scheme diagnosed unbalanced chromosomal abnormalities that the cfDNA scheme had missed.

  3. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 INTRODUCTION • The purpose of this study is to compare the simulated costs of five different prenatal screening methods. First-trimester combined screening risk 1 ≥ 250 1 ≥ 1000 General population Invasive testing cfDNA testing

  4. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 METHODS Data derived from French Biomedicine Agency Screening strategies FTS risk ≥1/250 FTS risk ≥1/1000 • 652653 women underwent FTS. • FTS risk ≥1/250 (n=26 136). • FTS risk ≥1/1000 (n=89 536). • Cost measures were derived from National Health Insurance payment scheme. • Five screening strategies were compared. FTS risk ≥1/250 FTS risk ≥1/1000 All pregnant women

  5. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 RESULTS Number of detected abnormalities per screening strategy. SCA , sex chromosomal abnormality; UBCA, unbalanced chromosomal abnormality.

  6. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 RESULTS Cost of each strategy (*million Euros)

  7. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 RESULTS Invasive: More expensive and more effective cfDNA: Cheaper, less effective Universal screening by cfDNA is NOT cost-effective.

  8. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 RESULTS Cost of cfDNA with varying baseline fees for cfDNA, invasive testing and consultation.

  9. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 CONCLUSIONS • The transition from invasive testing, for pregnancies with high risk, to cfDNA testing for a larger group of pregnancies, would result in an increase in the number of trisomies detected, but detection of fewer unbalanced chromosomal abnormalities and an additional economic burden, with no benefit in terms of miscarriage rate. • Invasive testing schemes are more expensive and more effective compared with cfDNA schemes. • Universal screening with cfDNA is not cost-effective.

  10. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis Le Bras et al., UOG 2019 POINTS FOR DISCUSSION • Potential implications of adding microarray testing to karyotyping for women undergoing invasive testing. • Extrapolating these results to your healthcare setting according to local fees for invasive testing and cfDNA.

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