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Cell‐free DNA for Down syndrome screening in obese women: Is it a cost‐effective strategy?
Author(s) -
Hopkins Maeve K.,
Dugoff Lorraine,
Durnwald Celeste,
Havrilesky Laura J.,
DottersKatz Sarah
Publication year - 2020
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5605
Subject(s) - cell free fetal dna , trisomy , medicine , aneuploidy , down syndrome , population , fetal weight , obstetrics , fetus , prenatal diagnosis , pregnancy , gynecology , chromosome , biology , biochemistry , genetics , environmental health , psychiatry , gene
Objective Determine cost differences between cell‐free DNA (cfDNA) and serum integrated screening (INT) in obese women given the limitations of aneuploidy screening in this population. Methods Using a decision‐analytic model, we estimated the cost‐effectiveness of trisomy 21 screening in class III obese women using cfDNA compared with INT. Primary outcomes of the model were cost, number of unnecessary invasive tests, procedure‐related fetal losses, and missed cases of trisomy 21. Results In base case, the mean cost of cfDNA was $498 greater than INT ($1399 vs $901). cfDNA resulted in lower probabilities of unnecessary invasive testing (2.9% vs 3.5%), procedure‐related loss (0.015% vs 0.019%), and missed cases of T21 (0.00013% vs 0.02%). cfDNA cost $87 485 per unnecessary invasive test avoided, $11 million per procedure‐related fetal loss avoided, and $2.2 million per missed case of T21 avoided. In sensitivity analysis, when the probability of insufficient fetal fraction is assumed to be >25%, cfDNA is both costlier than INT and results in more unnecessary invasive testing (a dominated strategy). Conclusion When the probability of insufficient fetal fraction more than 25% (a maternal weight of ≥300 lbs), cfDNA is costlier and results in more unnecessary invasive testing than INT.