{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:47:49Z","timestamp":1792266469021,"version":"4.4.0"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare universal and contingent non\u2010invasive prenatal testing (NIPT) strategies within a multi\u2010tariff healthcare system using a full incremental cost\u2010effectiveness framework and to identify price levels at which universal NIPT becomes economically competitive with the best reflex strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A deterministic decision\u2010analytic cohort model representing 1,000,000 pregnancies was developed. For each strategy, trisomy detection, false\u2010positive and missed cases, invasive procedures, procedure\u2010related fetal loss, and short\u2010term psychological quality\u2010adjusted life year (QALY) losses were estimated. Medical costs were derived from public, university, and private\u2010sector tariffs. Incremental costs, QALY losses avoided, and cost\u2010effectiveness ratios were calculated across all strategies; CT\u2010based pairwise analyses were retained as secondary analyses. Price\u2010threshold analyses and probabilistic sensitivity analysis generated threshold estimates and acceptability curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Contingent NIPT strategies markedly reduced false\u2010positive results and invasive procedures, yielding the lowest short\u2010term QALY losses. In full incremental analysis, Reflex300 was the only strategy on the frontier in private\u2010sector scenarios, whereas CT and Reflex300 remained on the frontier in SUT and university scenarios. uNIPT was not selected on the frontier and became economically competitive only at substantially reduced unit prices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Reimbursement structure strongly influenced cost\u2010effectiveness. Contingent NIPT was robust, whereas uNIPT required substantially lower tariff\u2010aligned pricing to become economically competitive.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pd.70282","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:20:14Z","timestamp":1792264814000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of Universal and Contingent NIPT Within a Multi\u2010Tariff Healthcare System: A Full Incremental Decision\u2010Analytic Cohort Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5695-2586","authenticated-orcid":false,"given":"Mehmet","family":"B\u00fclb\u00fcl","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology B\u00fclent Ecevit University Faculty of Medicine  Zonguldak T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7976-4123","authenticated-orcid":false,"given":"An\u0131l Turhan","family":"\u00c7ak\u0131r","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology B\u00fclent Ecevit University Faculty of Medicine  Zonguldak T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5638-3675","authenticated-orcid":false,"given":"Ger\u00e7ek","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Istanbul Health and Technology University  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9734-5253","authenticated-orcid":false,"given":"Mehmet \u0130brahim","family":"Harma","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology B\u00fclent Ecevit University 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