International Journal of Healthcare Management

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First-trimester screening versus non-invasive

prenatal testing for Down syndrome at high-
risk pregnant women in Hanoi Obstetrics and
Gynecology Hospital, Vietnam: A cost-utility
analysis

Nguyen Duy Anh, Le Dao Mai Trang & Nguyen Quynh Anh

To cite this article: Nguyen Duy Anh, Le Dao Mai Trang & Nguyen Quynh Anh (2020): First-
trimester screening versus non-invasive prenatal testing for Down syndrome at high-risk pregnant
women in Hanoi Obstetrics and Gynecology Hospital, Vietnam: A cost-utility analysis, International
Journal of Healthcare Management, DOI: 10.1080/20479700.2020.1758893

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Published online: 12 May 2020.

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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
https://doi.org/10.1080/20479700.2020.1758893

First-trimester screening versus non-invasive prenatal testing for Down

syndrome at high-risk pregnant women in Hanoi Obstetrics and Gynecology
Hospital, Vietnam: A cost-utility analysis
a
Nguyen Duy Anh , Le Dao Mai Tranga and Nguyen Quynh Anh b

a
Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam; bDepartment of Health Economics, Hanoi University of Public Health, Hanoi,
Vietnam

ABSTRACT ARTICLE HISTORY

Background: Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of Received 31 January 2020
fetal aneuploidies in the context of a developing country like Vietnam. Currently, first-trimester Accepted 13 April 2020
screening (FTS) is more conventional in Vietnam. NIPT is assumed to be more accurate than
KEYWORDS
other maternal screening but is also more costly. The purpose of the study was to perform a Cost-utility analysis; Down
cost-utility analysis comparing the FTS and NIPT for Down syndrome for high-risk pregnant syndrome; first-trimester
women (over 35-year-old) in Vietnam. screening; non-invasive
Methods: Decision tree model and probabilistic sensitivity analysis were used. prenatal test; Hanoi
Results: With the modelling population of 27,232 over 35 years of age pregnant women, FTS obstetrics and gynecology
helps detect 218.5 cases of the fetus with Down syndrome compared with 247.2 cases when hospital
screening with NIPT. In addition, NIPT reduced 1384 false-positive cases compared to FTS.
From a societal perspective, NIPT-dominated FTS. Compared to FTS, adopting an NIPT would
cost an additional of USD 3,800 for each additional quality-adjusted life-year gained.
Conclusions: NIPT is a cost-effective alternative to FTS for prenatal screening for Down
syndrome with high-risk pregnant women. This is a very first attempt on cost-utility analysis
of prenatal screening methods for Down syndrome in Vietnam and recommendations are
made for future research to determine the most cost-effectiveness methods.

Introduction found a way to screen for Down syndrome with a

According to the World Health Organization (WHO)
statistics, the estimated rate of children with Down
syndrome is 1/700–1/1100 births worldwide [1]. In
Vietnam, there are currently no official statistics on
the rate of children with Down syndrome, but accord-
ing to estimates of the General Department of Popu-
lation and Family Planning, there are about 1400–
1800 new-born children with the Down syndrome
each year. Hanoi Obstetrics and Gynecology Hospital
is the first-class specialized hospital of the city. In
2018, the Hospital examined and treated 680,264
turns of patients, the total number of births was
56,425. Currently, the hospital is conducting screening
for Down syndrome following the screening process
issued by the Ministry of Health: combined screening
in the first-trimester of pregnancy (FTS) – this is the
time to be evaluated by obstetric specialists as a ‘golden
moment’ in screening for birth defects, with high-risk
detection advising and appointing amniocentesis to
determine whether the fetus has Down syndrome
[2,3]. However, combined screening has a false-positive
rate of 5–7%, amniocentesis has a miscarriage rate of
1–2%. Since 1997, researchers around the world have
fetal DNA test in maternal blood, which is called a
non-invasive antenatal test (NIPT). NIPT is a relatively
new screening method in the context of a developing
country like Vietnam. NIPT is assumed to be more
accurate, with high accuracy (>98%), low false-positive
rate (<1%) than other maternal screening but is also
more costly. Thus, NIPT minimizes the risk associated
with invasive diagnostic testing (amniocentesis, chorio-
nic villus sampling). NIPT can be undertaken as early
as the 10th week of pregnancy.
From the above reasons, we conducted the study
cost-utility analysis of combined screening in the first
3 months of pregnancy versus non-invasive prenatal
test for Down syndrome for high-risk pregnant
women (> 35 years of age) at Hanoi Obstetrics and
Gynecology Hospital in 2019 from the societal perspec-
tive. Research results would provide health prac-
titioners comprehensive and accurate information
regarding both cost and effectiveness of different
screening methods in order to assist pregnant women
and their families get the right choice in accepting or
not accepting prenatal screening for Down syndrome
to reduce the burden of disease, improve the quality
of life of the population.

CONTACT Nguyen Quynh Anh nqa@huph.edu.vn Department of Health Economics, Hanoi University of Public Health, 1A Duc Thang Road, North Tu
Liem District, Hanoi 10000, Vietnam
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 N. D. ANH ET AL.

Methods screening methods using for calculating the number

of cases of fetus with Down syndrome detected and
Research was conducted in two steps:
the number of cases of false-positive was taken from
Step 1 – Selection of screening or test to be analyzed:
the study of Li et al. [5] and Taylor-Phillips et al.
Screening or test was selected according to the criteria
[6]. The transition probabilities of different screening
(1) feasibility of implementation at Hanoi Obstetrics
methods were calculated based on national and inter-
and Gynecology Hospital, (2) relevance to the current
national data including a meta-analysis of Akoleka
concern of the hospital Board of Directors, (3) avail-
et al. [7], a systematic review of Natoli et al. [8], a
ability of evidence regarding the effectiveness of screen-
cohort study by Li et al. [5], a meta-analysis of Tay-
ing or test; (4) availability of information about the cost
lor-Phillips et al. [6]; a systematic review of Neyt
of screening or test. From those criteria, taken into
et al. [9]. The QALYs were adopted from the cost-uti-
comparison are FTS and NIPT.
lity analysis study of prenatal diagnosis performed by
Step 2 – Building models and analyzing.
Harris et al. [10], the study of surgical abortion and
Model building: Decision tree model was designed
the effects of living with Down syndrome by Kupper-
to calculate the cost and effectiveness of screening pro-
mann et al. [11]. The number of QALYs of people liv-
tocols for high-risk pregnant women (over 35 years of
ing with Down syndrome was taken from a study by
age). The model was built to simulate the shift between
Mok et al. [12]. In this study, the time was calculated
different conditions of screening options for high-risk
for the case of spontaneous miscarriage, abortion due
pregnant women. The probabilities of transitions
to amniocentesis was one year; the time duration for
among states were estimated based on national and
Down syndrome baby born was calculated based on
international data. We based the cost-utility analysis
the average age of people with Down syndrome is
upon a hypothetical cohort of pregnant women who
58 years [13]; the life-year time for a non-Down syn-
registered for screening and birth delivery at Hanoi
drome baby born was based on the average life
Obstetrics and Gynecology Hospital in 2019, i.e.
expectancy of Vietnamese people is 76 [13]. Discount
23,191 women 35–39 years old and 4041 women over
rate of 3% was applied for QALYs.
40 years old from the total of 175,689 pregnant
Incremental cost-utility ratio (ICUR) calculation and
women of all age registered for screening and birth
uncertainty analysis: The results are presented as
delivery. Down syndrome prevalence for different age
an ICUR. ICUR was calculated according to the
groups was taken from the Morris et al.’s study [4].
formula:
The model was constructed using Microsoft Excel.
Decisions tree model for NIPT and FTS protocols are Cost2 − Cost1
ICUR =
provided in Figure 1. Utility2 − Utility1
Cost measurement: Cost of different scenarios was
(With Cost1 and Utility1 is FTS and Cost2 and
estimated from societal perspective. Cost data were
Utility2 is NIPT). ICUR means that in order to gain 1
collected in 2019, starting from the time the pregnant
more unit of effectiveness, it needs to add or save
woman started her pregnant cycle till giving birth
how many units of cost.
because the time in the model was short so no dis-
Because modeling techniques produced results in
count used. Costs include direct medical costs
uncertain conditions (due to input parameters and
(including the cost of FTS or NIPT, amniocentesis,
models), Monte Carlo simulation technique (1000
spontaneous miscarriage, pregnancy suspension, giv-
times) using the Excel built-in macros was undertaken
ing birth.) and direct non-medical costs (cost of tra-
for uncertainty analysis. During each iteration of the
veling and meals if needed). The data were collected
probabilistic sensitivity analysis, the model costs and
from the existing invoice of pregnant women at
probabilities were randomly drawn and a simulation
Hanoi Obstetrics and Gynecology Hospital as well
was completed using the drawn values. Normally, the
as interviewed pregnant women and family members.
costs were drawn from gamma distributions while
The cost parameters, values, and data sources are
the probabilities are drawn from beta distributions
described in Table 1.
[14]. The input parameters and distributions were pro-
Effectiveness measurement: Health outcome of
vided in Table 2.
pregnant women taken NIPT when compared with
FTS was estimated by the difference in quality-
adjusted life years (QALYs). The difference in total Results
QALYs was measured by the changes in the number
Cost estimates
of cases of fetus with Down syndrome detected and
the number of cases of false-positive when pregnant The estimated cost results for each alternative are listed
women taken NIPT compared with FTS multiplied in Table 3.
with the difference in the QALYs for different health As NIPT is relatively expensive in comparison with
conditions. Specificity and sensitivity of each FTS, it made the total cost of NIPT was USD 4.09
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 3

Figure 1. Decisions tree model for NIPT and FTS protocols.

millions higher than FTS for the model population. FTS. Although taking NIPT scenarios was lower in cost
However, the total cost of amniocentesis in case of taking of amniocentesis as well as cost of birth delivery, the total
NIPT was USD 1.139 millions lower than FTS as a result cost of NIPT scenario was USD 2.688 millions higher
of much lower in false-positive of NIPT compared with than FTS for the model population.
4 N. D. ANH ET AL.

Table 1. Detailed cost estimates including cost elements, cost value and data sources.
Cost elements Value Data sources
Direct medical cost
Cost of NIPT 1,500,000 (USD 65) Announced price list of Hanoi Obstetrics and Gynecology Hospital
Cost of FTS 5,000,000 (USD 215) Announced price list of Hanoi Obstetrics and Gynecology Hospital
Cost of amniocentesis 9,800,000 (USD 420) Announced price list of Hanoi Obstetrics and Gynecology Hospital
Cost of spontaneous miscarriage 877,000 (USD 38) Announced price list of Hanoi Obstetrics and Gynecology Hospital
Cost of birth delivery 3,244,000 (USD 140) Announced price list of Hanoi Obstetrics and Gynecology Hospital
Direct non-medical cost
Cost of traveling 143,458 (USD 6) Interviewed 223 Pregnant women at Hanoi Obstetrics and Gynecology Hospital
Cost of meals 64,335 (USD 3) Interviewed 223 Pregnant women at Hanoi Obstetrics and Gynecology Hospital
Discount rate for cost 0%
Discount rate for effectiveness 3%
Note: unit: VND and USD.

Table 2. Input parameters, distributions used in uncertainty analyses and sources.

Parameter Value (Mean, 95% CI) Uncertainty distribution Data sources
Down syndrome prevalance
35–39 years old 0.00616888 Beta [4]
(0.0050831565; 0.0072546020)
≥40 years old 0.02767580 Beta [4]
(0.0223100819; 0.0330415137)
Effectiveness of the screening tests
Sensitivity of NIPT 97.0% Beta [6]
Specificity of NIPT 99.7% Beta [6]
Sensitivity of FTS 85.71% Beta [5]
Specificity of FTS 94.57% Beta [5]
Quality-adjusted life years of different health states
Amniocentesis 0.76 (0.68; 0.94) Beta [11]
Pregnancy suspension 0.836 (0.4, 1.0) Beta [10]
Spontaneous miscarriage /abortion 0.76 (0.68; 0.94) Beta [11]
Birth delivery (baby with Down syndrome) 0.69 (0.54; 0.88) Beta [11]
Birth delivery (baby without Down syndrome) 0.923 (0.62; 1) Beta [10]
Baby with Down syndrome 0.55 (0.28; 0.82) Beta [12]

Table 3. Total cost of screening methods for Down syndrome for high-risk pregnant women (23,191 women 35–39 years old and
4041 women ≥ 40 years old).
FTS NIPT Difference
Cost items (1) (2) (2) – (1)
Total cost of screening/test method 1,753,119.85 5,843,732.83 4,090,612.98
Total cost of amniocentesis 1,139,089.42 0 −1,139,089.42
Total cost of pregnancy suspension 6557.09 7,578.25 1021.16
Total cost of birth delivery 3,739,042 3,736,478.08 −2564.13
Total of direct medical cost 6,637,808.56 9,587,789.16 2,949,980.59
Total of direct non-medical cost 775,052.20 513,085.01 −261,967.19
Total costs 7,412,860.76 10,100,874.17 2,688,013.41
Note: Unit: USD.

Effectiveness estimates Cost-utility results

The estimated effectiveness of each alternative is listed
in Table 4.
The number of cases of Down syndrome detected
when giving NIPT to all model population was 28.8
cases higher than giving FTS. However, as a result of
higher in both sensitivity and specificity, all other nega-
tive – effectiveness criteria (for example, number of
cases of birth delivery with Down syndrome, number
of cases of miscarriage due to amniocentesis) when giv-
ing NIPT were much lower than giving FTS to the
model population. Consequently, the total QALYs
even discounted or not discounted of taking NIPT
were higher than taking FTS (i.e. 434.5 and 707.1
QALYs, respectively).
The ICUR of the NIPT option and the FTS option for
prenatal screening of Down syndrome for high-risk
pregnant women was USD 3,800/1 additional dis-
counted QALYs. It means that using NIPT method
in comparison with FTS, in order to extend by 1
QALYs for over 35 years of age pregnant women, we
spend USD 3,800 (equivalent to VND 88,571,426.6)
more than FTS (Table 5).
When comparing the results of the ICUR with the
effective cost threshold recommended by the WHO
(one time GDP/capita/year in Vietnam in 2019 was
USD 1,960 and three times GDP/capita/year was USD
5,880), the NIPT option is more cost-effective than
FTS option in prenatal screening for Down syndrome
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 5

Table 4. Total effectiveness of screening methods for Down syndrome for high-risk pregnant women (23,191 women 35–39 years
old and 4,041 women ≥ 40 years old).
FTS NIPT Difference
Effectiveness (1) (2) (2) – (1)
Number of cases of Down syndrome detected 218.5 247.2 28.8
Number of cases of false-positive 1464.8 80.9 −1383.9
Number of cases of false-negative 36.4 7.6 −28.8
Number of cases of miscarriage due to amniocentesis 21.9 13.2 −8.7
Number of cases of birth delivery with Down syndrome 77.5 50.1 −27.4
Total of QALYs (not discounted) 1,177,603.5 1,178,038.0 434.5
Total of QALYs (discounted) 670,284.5 670,991.6 707.1

Table 5. Results of cost-effectiveness analysis of screening options in high-risk populations of 23,191 pregnant women.
FTS NIPT Difference
(1) (2) (2) – (1)
Total costs (USD) 7,412,860.76 10,100,874.17 2,688,013.41
Number of cases of Down syndrome detected 218.5 247.2 28.8
Number of cases of birth delivery with Down syndrome 77.5 50.1 −27.4
Total of QALYs (discounted) 670,284.5 670,991.6 707.1
ICER (total costs/QALYs discounted) 3,800
ICER (total costs/1 case of birth delivery with Down syndrome averted) 98,222
Cost-effectiveness threshold 1 × GDP = USD 1,960 3 × GDP = USD 5,880
Cost-effectiveness? Yes

for high-risk pregnant women. The results of the study
are similar to studies evaluating the cost-effectiveness
of NIPT and FTS in prenatal screening of Song et al.
in the USA in 2013 [15], study of Neyt et al. in Belgium
in 2014 [9].
Uncertainty analysis
In order to control uncertainty due to input par-
ameters, probabilistic sensitivity analysis using
Monte Carlo simulation techniques were adopted
and the average value both in terms of cost and
effectiveness for 1,000 simulations were estimated,
specifically.
As presented in the north-east quadrant of the cost-
effectiveness plane, high-risk pregnant women using
NIPT was more effective but also more costly than
FTS with incremental total costs run from a low of
USD 2,582,930.81 to a high of USD 2,793,096.00 and
incremental QALYs (discounted) run from a low of
695.77 to a high of 718.47. Thus, incremental cost-uti-
lity ratios when comparing NIPT with FTS was USD
3,800/1 additional discounted QALYs (95% CI:
3520.75 to 4081.94). The results of the simulation
analysis were not different from the deterministic
analysis (Figure 2).
women over 35 years old, the sensitivity and
specificity of FTS were 85.71% (95% CI:
63.63% to 96.78%) and 94.57% (95% CI:
93.64% to 95.4%), respectively [5]. The effectiveness
of FTS used in this study was similar to the cost-
effective study of NIPT and FTS by Morris et al.
done in the UK in 2013, Song et al. conducted
in 2013 in the USA and Okun’s study done in
Canada (85% sensitivity) [15–17]. However, the
effectiveness of FTS in this study was higher than
that of some other cost-effective studies, such as
the Belgian study by Neyt et al. [9] (72.5% sensi-
tivity and 95% specificity), research conducted in
Australia by Garfield et al. (81% sensitivity and
94.1% specificity) [18].
The effectiveness of NIPT in this study was based
on data from a systematic review and meta-analysis
of 41 clinical trials of Sian Taylor-Phillips conducted
in 2015 [6]. The sensitivity and specificity of NIPT
for high-risk pregnant women were 97% and 99.7%.
This effectiveness was lower than the NIPT effec-
tiveness used in Neyt et al.’ cost-effective study,
Garfield’s study and Peter O’Leary’s (100%
sensitivity and specificity), the study of Mika
Ohno et al. have 99% sensitivity and specificity
[9,17–19].

Effectiveness of different screening methods

Discussion
Input parameter in the model
The sensitivity and specificity of FTS in this study
were based on the results of the study ‘The assess-
ment of combined first-trimester screening in
women of advanced maternal age in an Asian
cohort” by Li et al., specifically, for pregnant
When comparing NIPT and FTS, NIPT was more
effective than FTS, specifically, for pregnant women
aged 35–39, this group of pregnant women were
identified as high risk of having a child with
Down syndrome, when NIPT was performed, it
detected 13.3% more cases of Down syndrome, the
number of false-positive cases was 94.5% lower
6 N. D. ANH ET AL.

Simulation results of Incremental cost effectiveness of FTS and NIPT for high-risk pregnant
women
Deterministic result of Incremental cost effectiveness of FTS and NIPT for high-risk pregnant
women
Cost – Effectiveness threshold (one time and three times GDP/capita)

Figure 2. Graph of simulation results of Incremental cost-effectiveness of FTS and NIPT for high-risk pregnant women.

than FTS. The remaining, for pregnant women over
40 years old, NIPT also detected more than 12% of
cases of Down syndrome, the number of false-posi-
tive cases was 94.3% lower than FTS. The study
results showed that NIPT’s superior effect on FTS,
especially for high-risk women (over 35 years old).
This result was similar to the research results of
Susan Garfield et al. done in 2012 in the USA;
research by Song et al. in 2013 for high-risk
women in the USA and Okun et al.’s study in
2014 in Canada [15,17,18].
In the study of Garfield et al., the results showed that
when performing NIPT for high-risk pregnant women,
66% reduction in invasive abortion cases and 38%
more detected cases of Down syndrome were detected
[18]. The results of Song’s study of high-risk pregnant
women also showed that NIPT detected 28-43% more
cases of Down syndrome, reducing 95% of invasive
procedures compared with FTS [15]. Okun et al.’s
study based on data in Canada showed that NIPT
found more than FTS 7 cases of Down syndrome
[17]. The study by Benn et al. showed that NIPT
found 96.5% more cases of Down compared with
85.9% of conventional screening and a 60% reduction
of unnecessary invasive procedures due to false-posi-
tive results [20].
Cost estimation
The study results showed that the cost for NIPT screen-
ing played a high proportion of the total cost, thus the
average cost of detecting 1 case of Down syndrome was
also higher than FTS. This result was different from
Okun et al.’s study based on data in Canada 2014, Beu-
len et al. 2014 in The Netherlands, Song et al. in 2013
[15,17,21]. In Okun et al.’s study, the cost of NIPT
detecting a case of Down syndrome was lower than
FTS, this difference may be due to the perspective of
identifying and calculating the total cost of Okun’s
research, from the sponsor’s perspective for prenatal
screening activities [17].
In Beulen et al.’s study, the cost of detecting a case of
Down syndrome by NIPT was also lower than FTS, but
this study also calculated the total cost from the provi-
der’s perspective [21]. However, in the study of Ayres
et al. conducted in 2014 with results similar to our
results, the cost to detect a case of Down syndrome
with NIPT was higher than that of FTS (Au$

1,094,608 equivalent to about VND 18,128,897,696)
[22]. In our research, the cost of NIPT was higher
than FTS compared with almost other research, it
can be explained by the fact that NIPT was relatively
new high technology screening methods in Vietnam.
Cost-utility analysis
NIPT was dominant when compared to FTS in prena-
tal Down syndrome screening, this result was similar to
other research results of Peter Benn, Stephen Morris,
Ken Song, Tony Yew Teck Tan [1,15,16,20]. The deter-
ministic analysis showed that the ICER of NIPT com-
pared with FTS for over 35 years age pregnant women
was USD 3,800/1 additional QALY (discounted),
which was lower than three times GDP/capita in Viet-
nam. Similar findings were reported by Lean Beulen.
Specifically, NIPT detected 452 cases of Down syn-
drome, FTS detected 294 cases; NIPT had 5 cases of
false-positive, and FTS had 52 cases. When using
NIPT, the total cost for each pregnant woman
increased by 157% compared to FTS, but ultimately,
NIPT was more cost-effective than FTS among preg-
nant women at high risk of developing fetus with
Down syndrome (i.e. over 35 years old) [21]. The
results of Song et al.’s research in 2013 in USA showed
that NIPT was more cost-effective compared to FTS in
pregnant women over 35 years old [15].
Strengths and limitations
To the best of our knowledge, we are the first to evaluate
the cost-effectiveness of Down syndrome prenatal
screening with non-invasive prenatal testing and screen-
ing results in the first 3 months of pregnancy using mod-
eling techniques in the context of Hanoi Obstetrics and
Gynecology Hospital. This study has certain strengths:
First, information used for the input parameters of the
decision tree model was the best available and reliable
source, including the input parameters, the effectiveness
of screening, the probability of transitions in the model,
the QALYs and cost corresponding for two screening
methods. Second, to control the uncertainty of the
input parameters, probabilistic sensitivity analysis tech-
niques were applied. Probability sensitivity analysis was
a Monte Carlo simulation for all input parameters of the
model performed to measure the impact of the input
parameter uncertainty on the conclusion of the cost-
effectiveness of screening methods. The results of 1000
simulations were presented in the incremental cost-
effectiveness plane. The results of probability sensitivity
analysis showed that the result of the cost-effectiveness
analysis using a decision tree model was reliable.
However, this study also has some limitations. First,
we used some information from randomized con-
trolled trials and cost-effectiveness studies on the
same topic conducted in developed countries, not in
Vietnam, for example, the effectiveness of a non-
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 7
invasive prenatal test, the QALYs of different health
states in the model. Next, the difference in pregnant
women resulted in a difference in pregnancy character-
istics, examination costs, birth delivery costs, and other
expenses. Modeling the screening effectiveness on the
average case and the average cost may not be comple-
tely accurate. The possible solution is to use micro-
simulation techniques; however, this technique
requires a lot of clinical and epidemiological infor-
mation of each individual that we cannot have. There-
fore, the use of decision tree model techniques with
data sources for input parameters as in this study is
the best solution in the current context. Lastly, NIPT
is able to screen for other prenatal abnormalities such
as Patau syndrome, Edward syndrome, and some sex-
ual chromosomal abnormalities, but in this study, we
only focus on prenatal screening for Down syndrome.
Finally, health policymakers in Vietnam could rely
on this cost-utility analysis to tailor reproductive health
plan for high-risk pregnant women (over 35-year-old),
for instant including NIPT in the standard care for tar-
get population or subsidy for NIPT in order to increase
the access to NIPT. Further research on the availability
of the healthcare services as well as sustainability for
the health insurance fund, same approach as research
by Afful-Dadzie et al. [13], should be done to provide
more evidence beforehand.
Conclusion
The results of the study allow to draw conclusions for
high-risk pregnant women (over 35-year-old), that pre-
natal screening for Down syndrome with NIPT should
be performed. Although some limitations exist, this is
still one of the cost-utility analysis of prenatal screening
for Down syndrome with FTS and NIPT, which is rela-
tively well implemented in Vietnam. Further medical
and economic assessments should be done further to
provide more evidence for policymaking regarding ante-
natal screening. At the same time, the improvement of
the availability of secondary information sources for
health economic assessment of antenatal screening
issues in Vietnam should also be emphasized.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes on contributors
Nguyen Duy Anh, Ph.D., Associate Professor, Director,
Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.
Le Dao Mai Trang, MPH, Communication Department,
Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.
Nguyen Quynh Anh, M.Sc., Ph.D., Lecturer, Department of
Health Economics, Hanoi University of Public Health,
Hanoi, Vietnam.
8 N. D. ANH ET AL.
ORCID
Nguyen Duy Anh http://orcid.org/0000-0003-1205-7074
Nguyen Quynh Anh http://orcid.org/0000-0003-2961-
7971
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