{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:27:58Z","timestamp":1784262478750,"version":"3.55.0"},"reference-count":39,"publisher":"Walter de Gruyter GmbH","issue":"3","license":[{"start":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T00:00:00Z","timestamp":1638489600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpm-2021-0467_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>A financial analysis is carried out to assess costs and benefits of providing cell-free DNA screening in Finland, using different strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2021-0467_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Three cell-free DNA screening strategies are considered: Primary, all women; Secondary, those with positive Combined test; and Contingent, the 10\u201330% with the highest Combined test risks. Three costs are estimated: additional cost for 10,000 pregnancies compared with the Combined test; \u2018marginal\u2019 cost of avoiding a Down syndrome birth which occurs in a pregnancy that would have been false-negative using the Combined test; and marginal cost of preventing the iatrogenic loss of a non-Down syndrome birth which occurs in a pregnancy that would have been false-positive.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2021-0467_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Primary cell-free DNA will require additional funds of \u20ac250,000. The marginal cost per Down syndrome birth avoided is considerably less than the lifetime medical and indirect cost; the marginal cost per unaffected iatrogenic fetal loss prevented is higher than one benefit measure but lower than another. If the ultrasound component of the Combined test is retained, as would be in Finland, the additional funds required rise to \u20ac992,000. Secondary cell-free DNA is cost-saving as is a Contingent strategy with 10% selected but whilst when 20\u201330% costs rise they are\u00a0much less than for the Primary strategy and are cost-beneficial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2021-0467_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>When considering the place of cell-free DNA screening it is important to make explicit the additional and marginal costs of different screening strategies and the associated benefits. Under most assumptions the balance is favorable for Contingent screening.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpm-2021-0467","type":"journal-article","created":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T13:41:23Z","timestamp":1638538883000},"page":"233-243","source":"Crossref","is-referenced-by-count":5,"title":["Cost of providing cell-free DNA screening for Down syndrome in Finland using different strategies"],"prefix":"10.1515","volume":"50","author":[{"given":"Howard","family":"Cuckle","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Tel Aviv University , Ramat Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seppo","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Fetomaternal Medical Centre, Helsinki University Hospital and University of Helsinki , Helsinki , Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Kaisa","family":"Anttonen","sequence":"additional","affiliation":[{"name":"HUSLAB Laboratory of Genetics and Department of Clinical Genetics , HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki , Helsinki , Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5230-1698","authenticated-orcid":false,"given":"Vedran","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Fetomaternal Medical Centre, Helsinki University Hospital and University of Helsinki , Helsinki , Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,12,3]]},"reference":[{"key":"2023040100552199460_j_jpm-2021-0467_ref_001","doi-asserted-by":"crossref","unstructured":"Gil, MM, Accurti, V, Santacruz, B, Plana, MN, Nicolaides, KH. 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