Cell-free DNA for Down syndrome screening in obese women: Is it a cost-effective strategy?

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Hopkins, MK; Dugoff, L; Durnwald, C; Havrilesky, LJ; Dotters-Katz, S

Published Date

  • January 2020

Published In

Volume / Issue

  • 40 / 2

Start / End Page

  • 173 - 178

PubMed ID

  • 31803969

Electronic International Standard Serial Number (EISSN)

  • 1097-0223

Digital Object Identifier (DOI)

  • 10.1002/pd.5605


  • eng

Conference Location

  • England