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Article: Cost-effectiveness analysis of chromosomal microarray as a primary test for prenatal diagnosis in Hong Kong

TitleCost-effectiveness analysis of chromosomal microarray as a primary test for prenatal diagnosis in Hong Kong
Authors
KeywordsChromosomal microarray
prenatal diagnosis
cost effectiveness analysis
cost saving
Hong Kong
Issue Date2020
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcpregnancychildbirth/
Citation
BMC Pregnancy and Childbirth, 2020, v. 20, p. article no. 109 How to Cite?
AbstractBackground: Chromosomal microarray (CMA) has been shown to be cost-effective over karyotyping in invasive prenatal diagnosis for pregnancies with fetal ultrasound anomalies. Yet, information regarding preceding and subsequent tests must be considered as a whole before the true cost-effectiveness can emerge. Currently in Hong Kong, karyotyping is offered free as the standard prenatal test while genome-wide array comparative genome hybridization (aCGH), a form of CMA, is self-financed. A new algorithm was proposed to use aCGH following quantitative fluorescent polymerase chain reaction (QF-PCR) as primary test instead of karyotyping. This study aims to evaluate the cost-effectiveness of the proposed algorithm versus the current algorithm for prenatal diagnosis in Hong Kong. Methods: Between November 2014 and February 2016, 129 pregnant women who required invasive prenatal diagnosis at two public hospitals in Hong Kong were prospectively recruited. The proposed algorithm was performed for all participants in this demonstration study. For the cost-effectiveness analysis, cost and outcome (diagnostic rate) data were compared with that of a hypothetical scenario representing the current algorithm. Further analysis was performed to incorporate women’s willingness-to-pay for the aCGH test. Impact of government subsidies on the aCGH test was explored as a sensitivity analysis. Results: The proposed algorithm dominated the current algorithm for prenatal diagnosis. Both algorithms were equally effective but the proposed algorithm was significantly cheaper (p ≤ 0.05). Taking into account women’s willingness-to-pay for an aCGH test, the proposed algorithm was more effective and less costly than the current algorithm. When the government subsidy reaches 100%, the maximum number of diagnoses could be made. Conclusion: By switching to the proposed algorithm, cost saving can be achieved whilst maximizing the diagnostic rate for invasive prenatal diagnosis. It is recommended to implement aCGH as a primary test following QF-PCR to replace the majority of karyotyping for prenatal diagnosis in Hong Kong.
Persistent Identifierhttp://hdl.handle.net/10722/281229
ISSN
2017 Impact Factor: 2.331
2015 SCImago Journal Rankings: 1.397
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorCHUNG, CCY-
dc.contributor.authorChan, KYK-
dc.contributor.authorHui, PW-
dc.contributor.authorAu, PKC-
dc.contributor.authorTam, WK-
dc.contributor.authorLi, SKM-
dc.contributor.authorLeung, GKC-
dc.contributor.authorFung, JLF-
dc.contributor.authorChan, MCY-
dc.contributor.authorLuk, HM-
dc.contributor.authorMak, ASL-
dc.contributor.authorLeung, KY-
dc.contributor.authorTang, MHY-
dc.contributor.authorChung, BHY-
dc.contributor.authorKan, ASY-
dc.date.accessioned2020-03-09T09:51:52Z-
dc.date.available2020-03-09T09:51:52Z-
dc.date.issued2020-
dc.identifier.citationBMC Pregnancy and Childbirth, 2020, v. 20, p. article no. 109-
dc.identifier.issn1471-2393-
dc.identifier.urihttp://hdl.handle.net/10722/281229-
dc.description.abstractBackground: Chromosomal microarray (CMA) has been shown to be cost-effective over karyotyping in invasive prenatal diagnosis for pregnancies with fetal ultrasound anomalies. Yet, information regarding preceding and subsequent tests must be considered as a whole before the true cost-effectiveness can emerge. Currently in Hong Kong, karyotyping is offered free as the standard prenatal test while genome-wide array comparative genome hybridization (aCGH), a form of CMA, is self-financed. A new algorithm was proposed to use aCGH following quantitative fluorescent polymerase chain reaction (QF-PCR) as primary test instead of karyotyping. This study aims to evaluate the cost-effectiveness of the proposed algorithm versus the current algorithm for prenatal diagnosis in Hong Kong. Methods: Between November 2014 and February 2016, 129 pregnant women who required invasive prenatal diagnosis at two public hospitals in Hong Kong were prospectively recruited. The proposed algorithm was performed for all participants in this demonstration study. For the cost-effectiveness analysis, cost and outcome (diagnostic rate) data were compared with that of a hypothetical scenario representing the current algorithm. Further analysis was performed to incorporate women’s willingness-to-pay for the aCGH test. Impact of government subsidies on the aCGH test was explored as a sensitivity analysis. Results: The proposed algorithm dominated the current algorithm for prenatal diagnosis. Both algorithms were equally effective but the proposed algorithm was significantly cheaper (p ≤ 0.05). Taking into account women’s willingness-to-pay for an aCGH test, the proposed algorithm was more effective and less costly than the current algorithm. When the government subsidy reaches 100%, the maximum number of diagnoses could be made. Conclusion: By switching to the proposed algorithm, cost saving can be achieved whilst maximizing the diagnostic rate for invasive prenatal diagnosis. It is recommended to implement aCGH as a primary test following QF-PCR to replace the majority of karyotyping for prenatal diagnosis in Hong Kong.-
dc.languageeng-
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcpregnancychildbirth/-
dc.relation.ispartofBMC Pregnancy and Childbirth-
dc.rightsBMC Pregnancy and Childbirth. Copyright © BioMed Central Ltd.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectChromosomal microarray-
dc.subjectprenatal diagnosis-
dc.subjectcost effectiveness analysis-
dc.subjectcost saving-
dc.subjectHong Kong-
dc.titleCost-effectiveness analysis of chromosomal microarray as a primary test for prenatal diagnosis in Hong Kong-
dc.typeArticle-
dc.identifier.emailChan, KYK: ykchanc@hku.hk-
dc.identifier.emailHui, PW: apwhui@hkucc.hku.hk-
dc.identifier.emailFung, JLF: jasflf@connect.hku.hk-
dc.identifier.emailLuk, HM: lukhm@hku.hk-
dc.identifier.emailMak, ASL: makasl@hku.hk-
dc.identifier.emailLeung, KY: leungkyb@hkucc.hku.hk-
dc.identifier.emailTang, MHY: mhytang@hkucc.hku.hk-
dc.identifier.emailChung, BHY: bhychung@hku.hk-
dc.identifier.emailKan, ASY: kansya@hkucc.hku.hk-
dc.identifier.authorityChan, KYK=rp00453-
dc.identifier.authorityTang, MHY=rp01701-
dc.identifier.authorityChung, BHY=rp00473-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/s12884-020-2772-y-
dc.identifier.pmid32059709-
dc.identifier.pmcidPMC7023733-
dc.identifier.scopuseid_2-s2.0-85079360380-
dc.identifier.hkuros309265-
dc.identifier.volume20-
dc.identifier.spagearticle no. 109-
dc.identifier.epagearticle no. 109-
dc.publisher.placeUnited Kingdom-

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