OBJECTIVES:  The cfDNA test detects T21 with a higher accuracy than conventional prenatal screening. Cost-effectiveness, as well as other domains (e.g. ethics, preferences, organisation), must be assessed in order to recommend its use in France. Our aims were to systematically review cost-effectiveness analyses on the cfDNA test for T21 screening and to summarize the evidence. METHODS:  An update of the systematic review of the Belgian Health Care Knowledge Center, published in 2009, was performed by the French National Authority for Health up to April 2016. Inclusion was performed independently by two researchers; a third researcher resolved discrepancies. The following data was extracted: study type, perspective