Abstract
In Thailand, incidence of chromosomal abnormalities such as Down syndrome is 1:800 - 1:1,000, with the risk increasing with maternal age. However, 75-80 percent of newborns with Down syndrome are found in pregnant women who less than 35 years old. In 2016, the subcommittee on health promotion and disease prevention Under the National Health Security Board (NHSO) approved the screening of Down syndrome in pregnant women as a new benefit for pregnant women aged 35 and over, and the NHSO has had agreed to expand the quadruple test in pregnant women of all age groups (quadruple for all). In 2019, there was A report evaluating the Down Syndrome Prevention and Control Pilot Program in five provinces which found that the acceptance rate for quadruple screening was relatively high, but the results of quadruple screening were false positive around 95 percent. This situation resulted in a larger number of unnecessary amniocentesis which lead to the service system cannot support. Currently, there is a non-invasive prenatal screening test (NIPT), which is a screening test for chromosomal abnormalities of the fetus by examining the genetic material of the fetus in the mother's blood, such as Trisomy 13, Trisomy 18, Trisomy 21. This test is very high sensitivity and specificity. This study used a model decision-tree to analyze the cost and benefit of various prenatal chromosomal abnormalities screenings compared to no screening, and budget impact analysis From the cost-benefit analysis, it was found that, from a government perspective, NIPT was the most cost-effective among the three groups. It was found that pregnant women younger than 35 years had a 2.37:1 cost-benefit ratio. Pregnancy over 35 years, the proportion is 12.41 : 1 and all pregnant women the proportion is 5.44 : 1. Since the cost of NIPT testing is a factor that increases the cost-effectiveness of universal NIPT testing, at the NIPT test price of 1,805 baht (80 percent reduction) found that the increased budget from serum screening at the acceptance rate that varies from 50 to 100 percent is 19-39 million baht. In summary, there are policy recommendations as follows: Governments should introduce NIPT screening policy to screen all pregnant women nationally which may be required to limit the price of NIPT examination by various agencies to be in the range of approximately 1,800 – 2,000 baht.
