The Price of Performance
Notice bibliographique
Résumé
Cell-free fetal DNA (cffDNA) testing is validated for detecting Down syndrome (DS) and trisomies 18 and 13 in high-risk populations. Because cffDNA testing can decrease invasive diagnostic testing rates with its significantly reduced false-positive rate, it potentially could improve the safety of prenatal screening and diagnosis of DS. This study reports the outcomes of an economic model that was developed to examine the costs and performance outcomes associated with the introduction of cffDNA testing in Ontario. An algorithm of the current prenatal screening program for DS in Ontario was developed to analyze the performance and costs of this program. A modified algorithm was then developed, incorporating cffDNA testing after a positive first-trimester screening. The uptake rate of prenatal screening for DS, the screen positive rate, amniocentesis uptake rates after a positive screen, and screening performance were based on the most recent observed rates of these parameters in Ontario. Cost and performance outcomes were estimated for 8 different potential scenarios varying the primary screening test for DS or using cffDNA as a secondary screening test contingent on the primary screening test. The scenarios also varied screening test uptake based on ease and quality of test. Performance outcomes included the total number of amniocenteses performed, the total number of cases of DS detected prenatally, and the total number of iatrogenic pregnancy losses after amniocentesis on pregnancies not affected by DS. Cost outcomes included the total cost of the various programs, cost per woman screened, and cost per case of DS detected. Use of cffDNA testing as a second-tier test was associated with a significant reduction in the number of diagnostic amniocenteses performed and a decrease in iatrogenic pregnancy loss without a significant increase in total program cost based on the current cost of $795 for the cffDNA test. Optimized first-trimester screening performance and increased screening uptake would increase the total program cost and the cost per women screened but would reduce the cost per case of DS diagnosed prenatally. The cost for each additional case of DS diagnosed prenatally was $21,900 compared with $112,919 per case of DS diagnosed in the current system. With its current price, cffDNA as a primary screening test for DS would markedly increase the overall program cost, the cost per women screened, and the cost per case of DS diagnosed. If the uptake of screening remained the same, the total program cost using cffDNA as a primary screening test would be 4.9 times that of the current program. The cost per women screened and the cost per case of DS diagnosed would be 4.9 and 2.5 times higher, respectively. These results suggest that a prenatal DS screening system may benefit from secondary cffDNA testing that would reduce the need for invasive tests with only a small reduction in cases diagnosed and still maintain the use of the 11- to 13-week scan. However, such improved screening would lead to increased costs. Whether these additional costs are worth the improved screening needs further examination.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,066 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».