Budget impact of incorporating non-invasive prenatal testing in prenatal screening for Down syndrome in Turkey

Objectives: To provide information to the government about the budget impact of implementing non-invasive prenatal testing (NIPT) into prenatal screening strategies to detect Down syndrome (DS) in singleton pregnancies in Turkey; the likely costs or savings associated with NIPT in comparison to the current practice were calculated. Methods: A decision-analytic model was developed to calculate the cost estimates for 1,309,771 women who gave birth in 2016; 84.8% of whom were 35-years-of-age. The superior combined test (CT) among current strategies is compared with contingent NIPT for women 35-years-of-age; and usual practice of amniocentesis (AC) for women ? 35 years-of-age was replaced with universal NIPT. Results: When the market price of NIPT (1,077 PPPUS$) is used, contingent NIPT offered to high-risk women 35-years-of-age adds 34,907,225 PPPUS$; and for women-35 ? years-of-age the universal NIPT leads to 142,785,818 PPPUS$ more cost to the government compared to current strategies. The additional costs with NIPT are partially compensated by the cost-savings due to reduction of the number of invasive tests and procedure related losses (17,826,476 PPPUS$ for women 35-years-of-age and 37,070 PPPUS$ for women ? 35-years-of-age). Results are sensitive to the NIPT costs; with a lower cost of NIPT, a total saving would be 33,116,046 PPPUS$ with new strategies. Conclusions: NIPT might be the choice of prenatal screening strategies if its price is lowered to economically acceptable levels. Until that time, currently accepted protocols seem to be more realistic. On the other hand, decision makers should also consider possible savings and the women's quality of life that can be improved with the new technology.