Cost-Effectiveness and Budget Impact Analysis of Noninvasive Prenatal Testing (NIPT) for the Identification of Fetal Chromosomal Aneuploidies in Brazilian Private Healthcare System
Author(s)
Janaina Cardoso Marinho, Other1, Junior Fadim, PhD1, Ricardo dos Santos Simões, MD, PhD1, Julia Simoes Correa Galendi, PhD, MD2.
1Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil (NATS UB), São Paulo, Brazil, 2Associate Researcher, Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil (NATS UB), São Paulo, Brazil.
1Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil (NATS UB), São Paulo, Brazil, 2Associate Researcher, Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil (NATS UB), São Paulo, Brazil.
OBJECTIVES: This study assessed the cost-effectiveness and budget impact of introducing noninvasive prenatal testing (NIPT) for detecting common fetal chromosomal aneuploidies among pregnant women with singleton pregnancies, from the perspective of the Brazilian private healthcare system.
METHODS: A decision tree model with a one-year time horizon compared NIPT to the current standard of care, direct amniocentesis. The model incorporated women’s preferences for noninvasive or invasive testing, the diagnostic accuracy of NIPT, and the risk of miscarriage associated with amniocentesis. NIPT accuracy was obtained from a systematic review, and miscarriage rates were sourced from published literature. Cost and resource utilization data were drawn from a large private insurer. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the findings.
RESULTS: Among pregnant women with variable risk, implementing NIPT increased per-patient costs by R$ 1,759.52, reduced the number of amniocentesis procedures by 18.4%, and avoided 0.06% of procedure-related miscarriages. The incremental cost-effectiveness ratio (ICER) was R$ 3,183,442.50 per abortion avoided and R$ 9,550.33 per amniocentesis avoided. Sensitivity analyses indicated that the willingness to initiate chromosomal investigation was the most influential parameter. Probabilistic analyses confirmed that NIPT consistently resulted in higher costs but fewer invasive procedures and related miscarriages. The cumulative five-year budget impact for an estimated 243,845 eligible patients was R$ 943,914,520, assuming a market share increase from 10% in the first year to 80% by year five.
CONCLUSIONS: Incorporating NIPT for prenatal screening in women with varying risk profiles reduces the need for invasive procedures and associated miscarriages, although it increases costs for the private healthcare system. NIPT is most cost-effective in contexts with high demand for prenatal chromosomal investigation and frequent use of amniocentesis. These results provide valuable evidence to inform policy decisions regarding the adoption of NIPT in Brazilian private healthcare settings.
METHODS: A decision tree model with a one-year time horizon compared NIPT to the current standard of care, direct amniocentesis. The model incorporated women’s preferences for noninvasive or invasive testing, the diagnostic accuracy of NIPT, and the risk of miscarriage associated with amniocentesis. NIPT accuracy was obtained from a systematic review, and miscarriage rates were sourced from published literature. Cost and resource utilization data were drawn from a large private insurer. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the findings.
RESULTS: Among pregnant women with variable risk, implementing NIPT increased per-patient costs by R$ 1,759.52, reduced the number of amniocentesis procedures by 18.4%, and avoided 0.06% of procedure-related miscarriages. The incremental cost-effectiveness ratio (ICER) was R$ 3,183,442.50 per abortion avoided and R$ 9,550.33 per amniocentesis avoided. Sensitivity analyses indicated that the willingness to initiate chromosomal investigation was the most influential parameter. Probabilistic analyses confirmed that NIPT consistently resulted in higher costs but fewer invasive procedures and related miscarriages. The cumulative five-year budget impact for an estimated 243,845 eligible patients was R$ 943,914,520, assuming a market share increase from 10% in the first year to 80% by year five.
CONCLUSIONS: Incorporating NIPT for prenatal screening in women with varying risk profiles reduces the need for invasive procedures and associated miscarriages, although it increases costs for the private healthcare system. NIPT is most cost-effective in contexts with high demand for prenatal chromosomal investigation and frequent use of amniocentesis. These results provide valuable evidence to inform policy decisions regarding the adoption of NIPT in Brazilian private healthcare settings.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE222
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
Reproductive & Sexual Health