Cost-Effectiveness of Universal and Contingent NIPT Within a Multi-Tariff Healthcare System: A Full Incremental Decision-Analytic Cohort Study
In brief
Contingent prenatal screening led on cost-effectiveness; universal testing needed major price cuts
In a decision model of 1 million pregnancies, contingent non-invasive prenatal testing reduced false positives and invasive procedures, with the lowest short-term quality-of-life losses. It was the most cost-effective option across modeled healthcare tariffs, while universal testing became competitive only at substantially lower prices, underscoring how reimbursement levels shape which strategy offers value.
- Journal
- Prenatal diagnosis (Q1)
- Published
- 17 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Mehmet Bülbül, Anıl Turhan Çakır, Gerçek Aydın, Mehmet İbrahim Harma, Azize Cemre Öztürk, Aykut Barut, et al.
- PMID
- 42891977
- DOI
- 10.1002/pd.70282
Why clinicians should know about it
- Picked for Genetics (clinical) (top studies of the week, 25 October 2026): Cost-effectiveness analysis of universal vs contingent NIPT
Abstract
OBJECTIVE: To compare universal and contingent non-invasive prenatal testing (NIPT) strategies within a multi-tariff healthcare system using a full incremental cost-effectiveness framework and to identify price levels at which universal NIPT becomes economically competitive with the best reflex strategy. METHOD: A deterministic decision-analytic cohort model representing 1,000,000 pregnancies was developed. For each strategy, trisomy detection, false-positive and missed cases, invasive procedures, procedure-related fetal loss, and short-term psychological quality-adjusted life year (QALY) losses were estimated. Medical costs were derived from public, university, and private-sector tariffs. Incremental costs, QALY losses avoided, and cost-effectiveness ratios were calculated across all strategies; CT-based pairwise analyses were retained as secondary analyses. Price-threshold analyses and probabilistic sensitivity analysis generated threshold estimates and acceptability curves. RESULTS: Contingent NIPT strategies markedly reduced false-positive results and invasive procedures, yielding the lowest short-term QALY losses. In full incremental analysis, Reflex300 was the only strategy on the frontier in private-sector scenarios, whereas CT and Reflex300 remained on the frontier in SUT and university scenarios. uNIPT was not selected on the frontier and became economically competitive only at substantially reduced unit prices. CONCLUSIONS: Reimbursement structure strongly influenced cost-effectiveness. Contingent NIPT was robust, whereas uNIPT required substantially lower tariff-aligned pricing to become economically competitive.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.