The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada
ABSTRACT Objective To examine the cost and performance implications of introducing cell‐free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program. Method Two clinical algorithms were created: the first to represent...
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| Veröffentlicht in: | Prenatal diagnosis 2014-04, Vol.34 (4), p.350-356 |
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| creator | Okun, N. Teitelbaum, M. Huang, T. Dewa, C. S. Hoch, J. S. |
| description | ABSTRACT
Objective
To examine the cost and performance implications of introducing cell‐free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program.
Method
Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency‐based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR).
Results
This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing.
Conclusion
Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11‐ to 13‐week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased. © 2013 John Wiley & Sons, Ltd.
What's already known about this topic?
Cell‐free fetal DNA testing has been validated scientifically in the high‐risk population. Other cost analyses have documented potential cost savings via reductions in diagnostic tests required.
What does this study add?
This study provides a detailed analysis of both cost and performance implications of several potential implementation scenarios of cell‐free fetal DNA testing in a population‐based prenatal screening program. |
| doi_str_mv | 10.1002/pd.4311 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1520378469</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3264393301</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4161-4072e94aade81ecaab79c556823c87126683fa85116b0873ff2e80635ad7d23d3</originalsourceid><addsrcrecordid>eNqNkVtrFDEYhoModq3iP5CAFxV0ag6Tw3hXdm2r1K1oRfAmZCff6NSZZJrMUvd3-IebcdciguBVDjzvw5e8CD2m5JASwl4O7rDklN5BM0oqVRDG-F00IzTvuRZ0Dz1I6TKDmlXqPtpjJa8E4WSGfl58AzzEtgYcGjxAbELsra_hFba4DmnE1rs_7_PZdpvUpokfc7jthw568KMd2-Cn2xq6rmgiAG5gtB1eLI_wCGls_VecNXgRrj1OG-9i6HPe4_Mcjm14gedZ7uxDdK-xXYJHu3UffTp-fTE_Lc7OT97Mj86KuqSSFiVRDKrSWgeaQm3tSlW1EFIzXmtFmZSaNza_nsoV0Yo3DQNNJBfWKce44_vo2dY7xHC1zgOavk3T8NZDWCdDBSNc6VJW_4FSTgQVkmX06V_oZVjH_Gm_KMZ5paXI1MGWqmNIKUJjcgm9jRtDiZkqNYMzU6WZfLLzrVc9uFvud4cZeL4FrtsONv_ymPeLna7Y0m0a4cctbeN3IxVXwnxenpi3xx-WX5Yf3-XkDaOot08</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1512339865</pqid></control><display><type>article</type><title>The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Okun, N. ; Teitelbaum, M. ; Huang, T. ; Dewa, C. S. ; Hoch, J. S.</creator><creatorcontrib>Okun, N. ; Teitelbaum, M. ; Huang, T. ; Dewa, C. S. ; Hoch, J. S.</creatorcontrib><description>ABSTRACT
Objective
To examine the cost and performance implications of introducing cell‐free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program.
Method
Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency‐based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR).
Results
This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing.
Conclusion
Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11‐ to 13‐week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased. © 2013 John Wiley & Sons, Ltd.
What's already known about this topic?
Cell‐free fetal DNA testing has been validated scientifically in the high‐risk population. Other cost analyses have documented potential cost savings via reductions in diagnostic tests required.
What does this study add?
This study provides a detailed analysis of both cost and performance implications of several potential implementation scenarios of cell‐free fetal DNA testing in a population‐based prenatal screening program.</description><identifier>ISSN: 0197-3851</identifier><identifier>EISSN: 1097-0223</identifier><identifier>DOI: 10.1002/pd.4311</identifier><identifier>PMID: 24395030</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Amniocentesis - economics ; Amniocentesis - methods ; Amniocentesis - statistics & numerical data ; Chorionic Gonadotropin, beta Subunit, Human - analysis ; Cost-Benefit Analysis ; Costs and Cost Analysis ; DNA - analysis ; DNA - blood ; Down Syndrome - diagnosis ; Female ; Fetus - chemistry ; Humans ; Maternal Age ; Nuchal Translucency Measurement - economics ; Nuchal Translucency Measurement - statistics & numerical data ; Ontario ; Pregnancy ; Pregnancy-Associated Plasma Protein-A - analysis ; Prenatal Diagnosis - economics ; Prenatal Diagnosis - methods ; Prenatal Diagnosis - statistics & numerical data ; Sequence Analysis, DNA - economics ; Sequence Analysis, DNA - methods ; Sequence Analysis, DNA - statistics & numerical data</subject><ispartof>Prenatal diagnosis, 2014-04, Vol.34 (4), p.350-356</ispartof><rights>2013 John Wiley & Sons, Ltd.</rights><rights>2014 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4161-4072e94aade81ecaab79c556823c87126683fa85116b0873ff2e80635ad7d23d3</citedby><cites>FETCH-LOGICAL-c4161-4072e94aade81ecaab79c556823c87126683fa85116b0873ff2e80635ad7d23d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpd.4311$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpd.4311$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24395030$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Okun, N.</creatorcontrib><creatorcontrib>Teitelbaum, M.</creatorcontrib><creatorcontrib>Huang, T.</creatorcontrib><creatorcontrib>Dewa, C. S.</creatorcontrib><creatorcontrib>Hoch, J. S.</creatorcontrib><title>The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada</title><title>Prenatal diagnosis</title><addtitle>Prenat Diagn</addtitle><description>ABSTRACT
Objective
To examine the cost and performance implications of introducing cell‐free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program.
Method
Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency‐based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR).
Results
This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing.
Conclusion
Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11‐ to 13‐week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased. © 2013 John Wiley & Sons, Ltd.
What's already known about this topic?
Cell‐free fetal DNA testing has been validated scientifically in the high‐risk population. Other cost analyses have documented potential cost savings via reductions in diagnostic tests required.
What does this study add?
This study provides a detailed analysis of both cost and performance implications of several potential implementation scenarios of cell‐free fetal DNA testing in a population‐based prenatal screening program.</description><subject>Adult</subject><subject>Amniocentesis - economics</subject><subject>Amniocentesis - methods</subject><subject>Amniocentesis - statistics & numerical data</subject><subject>Chorionic Gonadotropin, beta Subunit, Human - analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Costs and Cost Analysis</subject><subject>DNA - analysis</subject><subject>DNA - blood</subject><subject>Down Syndrome - diagnosis</subject><subject>Female</subject><subject>Fetus - chemistry</subject><subject>Humans</subject><subject>Maternal Age</subject><subject>Nuchal Translucency Measurement - economics</subject><subject>Nuchal Translucency Measurement - statistics & numerical data</subject><subject>Ontario</subject><subject>Pregnancy</subject><subject>Pregnancy-Associated Plasma Protein-A - analysis</subject><subject>Prenatal Diagnosis - economics</subject><subject>Prenatal Diagnosis - methods</subject><subject>Prenatal Diagnosis - statistics & numerical data</subject><subject>Sequence Analysis, DNA - economics</subject><subject>Sequence Analysis, DNA - methods</subject><subject>Sequence Analysis, DNA - statistics & numerical data</subject><issn>0197-3851</issn><issn>1097-0223</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkVtrFDEYhoModq3iP5CAFxV0ag6Tw3hXdm2r1K1oRfAmZCff6NSZZJrMUvd3-IebcdciguBVDjzvw5e8CD2m5JASwl4O7rDklN5BM0oqVRDG-F00IzTvuRZ0Dz1I6TKDmlXqPtpjJa8E4WSGfl58AzzEtgYcGjxAbELsra_hFba4DmnE1rs_7_PZdpvUpokfc7jthw568KMd2-Cn2xq6rmgiAG5gtB1eLI_wCGls_VecNXgRrj1OG-9i6HPe4_Mcjm14gedZ7uxDdK-xXYJHu3UffTp-fTE_Lc7OT97Mj86KuqSSFiVRDKrSWgeaQm3tSlW1EFIzXmtFmZSaNza_nsoV0Yo3DQNNJBfWKce44_vo2dY7xHC1zgOavk3T8NZDWCdDBSNc6VJW_4FSTgQVkmX06V_oZVjH_Gm_KMZ5paXI1MGWqmNIKUJjcgm9jRtDiZkqNYMzU6WZfLLzrVc9uFvud4cZeL4FrtsONv_ymPeLna7Y0m0a4cctbeN3IxVXwnxenpi3xx-WX5Yf3-XkDaOot08</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Okun, N.</creator><creator>Teitelbaum, M.</creator><creator>Huang, T.</creator><creator>Dewa, C. S.</creator><creator>Hoch, J. S.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>7TM</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>201404</creationdate><title>The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada</title><author>Okun, N. ; Teitelbaum, M. ; Huang, T. ; Dewa, C. S. ; Hoch, J. S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4161-4072e94aade81ecaab79c556823c87126683fa85116b0873ff2e80635ad7d23d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Amniocentesis - economics</topic><topic>Amniocentesis - methods</topic><topic>Amniocentesis - statistics & numerical data</topic><topic>Chorionic Gonadotropin, beta Subunit, Human - analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Costs and Cost Analysis</topic><topic>DNA - analysis</topic><topic>DNA - blood</topic><topic>Down Syndrome - diagnosis</topic><topic>Female</topic><topic>Fetus - chemistry</topic><topic>Humans</topic><topic>Maternal Age</topic><topic>Nuchal Translucency Measurement - economics</topic><topic>Nuchal Translucency Measurement - statistics & numerical data</topic><topic>Ontario</topic><topic>Pregnancy</topic><topic>Pregnancy-Associated Plasma Protein-A - analysis</topic><topic>Prenatal Diagnosis - economics</topic><topic>Prenatal Diagnosis - methods</topic><topic>Prenatal Diagnosis - statistics & numerical data</topic><topic>Sequence Analysis, DNA - economics</topic><topic>Sequence Analysis, DNA - methods</topic><topic>Sequence Analysis, DNA - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Okun, N.</creatorcontrib><creatorcontrib>Teitelbaum, M.</creatorcontrib><creatorcontrib>Huang, T.</creatorcontrib><creatorcontrib>Dewa, C. S.</creatorcontrib><creatorcontrib>Hoch, J. S.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Prenatal diagnosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Okun, N.</au><au>Teitelbaum, M.</au><au>Huang, T.</au><au>Dewa, C. S.</au><au>Hoch, J. S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada</atitle><jtitle>Prenatal diagnosis</jtitle><addtitle>Prenat Diagn</addtitle><date>2014-04</date><risdate>2014</risdate><volume>34</volume><issue>4</issue><spage>350</spage><epage>356</epage><pages>350-356</pages><issn>0197-3851</issn><eissn>1097-0223</eissn><abstract>ABSTRACT
Objective
To examine the cost and performance implications of introducing cell‐free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program.
Method
Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency‐based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR).
Results
This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing.
Conclusion
Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11‐ to 13‐week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased. © 2013 John Wiley & Sons, Ltd.
What's already known about this topic?
Cell‐free fetal DNA testing has been validated scientifically in the high‐risk population. Other cost analyses have documented potential cost savings via reductions in diagnostic tests required.
What does this study add?
This study provides a detailed analysis of both cost and performance implications of several potential implementation scenarios of cell‐free fetal DNA testing in a population‐based prenatal screening program.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24395030</pmid><doi>10.1002/pd.4311</doi><tpages>7</tpages></addata></record> |
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| ispartof | Prenatal diagnosis, 2014-04, Vol.34 (4), p.350-356 |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Amniocentesis - economics Amniocentesis - methods Amniocentesis - statistics & numerical data Chorionic Gonadotropin, beta Subunit, Human - analysis Cost-Benefit Analysis Costs and Cost Analysis DNA - analysis DNA - blood Down Syndrome - diagnosis Female Fetus - chemistry Humans Maternal Age Nuchal Translucency Measurement - economics Nuchal Translucency Measurement - statistics & numerical data Ontario Pregnancy Pregnancy-Associated Plasma Protein-A - analysis Prenatal Diagnosis - economics Prenatal Diagnosis - methods Prenatal Diagnosis - statistics & numerical data Sequence Analysis, DNA - economics Sequence Analysis, DNA - methods Sequence Analysis, DNA - statistics & numerical data |
| title | The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada |
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