Fig 1.
Decision tree diagram for universal NIPT.
We assumed that women with failed NIPT would be tested with serum screening and that women with a serum screen risk greater or equal to 1:270 would be offered diagnostic testing. The decision tree is continued in the diagnostic testing tree (Fig 4).
Fig 2.
Decision tree diagram for contingent NIPT.
We assumed that women with failed NIPT whose risk was higher than or equal to 1:270 on the initial serum screen would be offered diagnostic testing. The decision tree is continued in the diagnostic testing tree (Fig 4).
Fig 3.
Decision tree diagram for MSS.
The decision tree is continued in the diagnostic testing tree (Fig 4).
Fig 4.
Decision tree diagram for diagnostic testing.
Table 1.
Model probabilities and costs.
Table 2.
Optimal risk cutoffs and the number of women receiving NIPT for contingent NIPT policies.
Table 3.
Detection rates, false positive rates, optimal risk cutoffs, and NIPT failure rates.
Table 4.
Total cost, cases detected, incremental costs, incremental cases detected and incremental cost effectiveness ratio (ICER).
Fig 5.
One-way sensitivity analysis of universal NIPT vs MSS from a societal perspective.
Below are the one-way sensitivity analysis results of the ICER between universal NIPT and MSS. Universal NIPT is less costly than MSS as long as the cost of NIPT remains below $619.
Fig 6.
Scatter plot of probabilistic sensitivity analysis, universal NIPT vs MSS.
The figure below plots the incremental cost and effectiveness results from 1,000 simulations. Compared to MSS, there is a 100% probability that universal NIPT is more effective and 91.8% probability that universal NIPT is less costly.
Fig 7.
One-way sensitivity analysis of contingent NIPT vs MSS from a government perspective.
Below are the one-way sensitivity analysis results of ICER between contingent NIPT and MSS. Contingent NIPT is less costly than MSS as long as the cost of NIPT remains below $663.
Fig 8.
Scatter plot of probabilistic sensitivity analysis of contingent NIPT vs. MSS from a government perspective.
The figure below plots the incremental cost and effectiveness results from 1,000 simulations. Compared to MSS, there is a 100% probability that contingent NIPT is more effective and a 87% probability that contingent NIPT is less costly.
Fig 9.
One-way sensitivity analysis of contingent NIPT vs MSS from a payer perspective.
Below are the one-way sensitivity analysis results of ICER between contingent NIPT and MSS. Contingent NIPT is more costly than MSS as long as the cost of NIPT is above $293, contingent NIPT uptake is above 72%, and the cost of invasive screening is below $1,235.
Fig 10.
Scatter plot of probabilistic sensitivity analysis of contingent NIPT vs MSS from payer perspective.
The figure below plots the incremental cost and effectiveness results from 1,000 simulations. Compared to MSS, there is a 100% probability that contingent NIPT is more effective but a 73.2% probability that contingent NIPT is more costly.