Study of sensitivity and optimization of the prenatal screening and diagnosis strategies for Down syndrome in China

Objective To conduct sensitivity analysis from the perspective of health economic on 5 kinds of Down syndrome(DS)prenatal screening and diagnosis strategies, so as to provide optimal suggestion in China.Methods Based on the field investigation of seven prenatal screening and diagnostic agency, cost effectiveness analysis was used to assess the economic value of 5 DS prenatal screening and diagnosis strategies in China. Besides, sensitivity analysis was carried out to evaluate the impact of cost and clinical parameters' uncertainty on the results of health economics evaluation.Results When the proportion of women over 35 years and the up-taken rate of non-invasive prenatal testing(NIPT) increased, the strategy with the lowest cost-effectiveness ratio was always the conditional NIPT screening strategy. When the price of NIPT was lower than 476 Yuan, the cost-effectiveness ratio of the full NIPT screening strategy was the lowest. The conditional NIPT screening strategy had the lowest cost-effectiveness ratio at each study site.Conclusion The conditional NIPT screening strategy should be promoted and the full-cycle pregnancy management network should be well constructed. Pregnant women's right of informed choices should be guaranteed in China. In addition, fixed subsidies should be provided for prenatal screening, and health education for pregnant women should be reinforced.